Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Watanabe, Atsuyuki; Yasuhara, Jun; Karube, Takaharu; Watanabe, Kae; Shirasu, Takuro; Takagi, Hisato; Sumitomo, Naokata; Lee, Simon; Kuno, Toshiki

doi:10.1097/pcc.0000000000003113

Cited by 10 publications

(24 citation statements)

References 67 publications

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“…This meta-analysis collected published data investigating the mRNA vaccines and indicated the associations between vaccination and lower risks of SARS-CoV-2 infections and COVID-19–related illnesses. Although children tend to develop milder symptoms than adults due to COVID-19, severe cases have still been identified . Our finding that mRNA vaccination in children aged 5 to 11 years was not only associated with lower risks of acute infection but also associated with lower risks of hospitalization and MIS-C was important since it will aid in addressing the misunderstandings that vaccination does not benefit children.…”

Section: Discussionmentioning

confidence: 77%

“…Although children tend to develop milder symptoms than adults due to COVID-19, 2 severe cases have still been identified. 4,5,47,48 Our finding that mRNA vaccination in children aged 5 to 11 years was not only associated with lower risks of acute infection but also associated with lower risks of hospitalization and MIS-C was important since it will aid in addressing the misunderstandings that vaccination does not benefit children.…”

Section: Discussionmentioning

confidence: 93%

“…59 Furthermore, the prognoses of MIS-C provoked by SARS-CoV-2 infection are likely to be much poorer than mRNA postvaccination myocarditis. 5,18,48,51 Given the incidence rate of MIS-C following SARS-CoV-2 infection among children aged 5 to 11 years, the protective effect of mRNA vaccines against MIS-C should be considered when discussing the risk-benefit balance of vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, the frequency of postvaccination myocarditis may be comparable with or slightly higher than the annual incidence rate of myocarditis before the COVID-19 pandemic in children . Furthermore, the prognoses of MIS-C provoked by SARS-CoV-2 infection are likely to be much poorer than mRNA postvaccination myocarditis . Given the incidence rate of MIS-C following SARS-CoV-2 infection among children aged 5 to 11 years, the protective effect of mRNA vaccines against MIS-C should be considered when discussing the risk-benefit balance of vaccination.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Efficacy and Safety of mRNA COVID-19 Vaccines in Children Aged 5 to 11 Years

et al. 2023

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ImportanceEvidence of the efficacy and safety of messenger RNA (mRNA) COVID-19 vaccines in children aged 5 to 11 years has been emerging. Collecting these data will inform clinicians, families, and policy makers.ObjectiveTo evaluate the efficacy and safety of mRNA COVID-19 vaccines in children aged 5 to 11 years in a systematic review and meta-analysis.Data SourcesPubMed and Embase databases were searched on September 29, 2022, without language restrictions.Study SelectionRandomized clinical trials and observational studies comparing vaccinated vs unvaccinated children aged 5 to 11 years and reporting efficacy or safety outcomes were included. Studies reporting safety outcomes in vaccinated children only (ie, no control group) were also included.Data Extraction and SynthesisTwo investigators independently extracted relevant data from each study. Odds ratios (ORs) for efficacy and safety outcomes and incidences of adverse events (AEs) following vaccination were synthesized using a random-effects model. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines.Main Outcomes and MeasuresThe primary outcome was SARS-CoV-2 infections with or without symptoms. The secondary outcomes included symptomatic SARS-CoV-2 infections, hospitalizations, and multisystem inflammatory syndrome in children. The incidences of each AE following vaccination were also evaluated.ResultsTwo randomized clinical trials and 15 observational studies involving 10 935 541 vaccinated children (median or mean age range, 8.0-9.5 years) and 2 635 251 unvaccinated children (median or mean age range, 7.0-9.5 years) were included. Two-dose mRNA COVID-19 vaccination compared with no vaccination was associated with lower risks of SARS-CoV-2 infections with or without symptoms (OR, 0.47; 95% CI, 0.35-0.64), symptomatic SARS-CoV-2 infections (OR, 0.53; 95% CI, 0.41-0.70), hospitalizations (OR, 0.32; 95% CI, 0.15-0.68), and multisystem inflammatory syndrome in children (OR, 0.05; 95% CI, 0.02-0.10). Two randomized clinical trials and 5 observational studies investigated AEs among vaccinated children. Most vaccinated children experienced at least 1 local AE following the first injection (32 494 of 55 959 [86.3%]) and second injection (28 135 of 46 447 [86.3%]). Vaccination was associated with a higher risk of any AEs compared with placebo (OR, 1.92; 95% CI, 1.26-2.91). The incidence of AEs that prevented normal daily activities was 8.8% (95% CI, 5.4%-14.2%) and that of myocarditis was estimated to be 1.8 per million (95% CI, 0.000%-0.001%) following the second injection.Conclusions and RelevanceIn this systematic review and meta-analysis, COVID-19 mRNA vaccines among children aged 5 to 11 years were associated with measures of efficacy in preventing SARS-CoV-2 infection and severe COVID-19–related illnesses. While most children developed local AEs, severe AEs were rare, and most of AEs resolved within several days. These data provide evidence for future recommendations.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of Efficacy and Safety of mRNA COVID-19 Vaccines in Children Aged 5 to 11 Years

et al. 2023

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“…In this issue of Pediatric Critical Care Medicine , Watanabe et al (10) addressed some of these gaps by conducting a systematic review of 44 studies of 110 children supported on ECMO for COVID-19. Overall mortality was 27%.…”

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confidence: 99%

Outcomes After Extracorporeal Membrane Oxygenation in Children With COVID-19*

MacLaren

Barbaro

Nardo³

2023

Pediatric Critical Care Medicine

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A s the COVID-19 pandemic spread across the globe, it became rapidly apparent that elderly patients were at the greatest risk of death and the young seemed inherently protected (1). However, as successive waves hit large population centers, the initial impression that children could not be seriously affected by the disease became untenable, particularly for those with preexisting health problems. COVID-19 can cause pediatric acute respiratory distress syndrome (PARDS), myocarditis, or multisystem inflammatory syndrome in children (MIS-C) (2, 3). Clinicians have employed extracorporeal membrane oxygenation (ECMO) support in the most severe cases, but the precise indications and treatment effect remain unclear.ECMO has been used far more extensively in adults than children throughout the pandemic, yet only very recently has evidence emerged that ECMO may confer a survival advantage in selected adult patients with COVID-19 (4-6). Outcomes have also changed over time as different treatments, viral variants, and vaccination have evolved (7,8). The evidence supporting the use of ECMO in non-neonatal children with respiratory failure of any cause is not particularly well established, let alone in those with COVID-19 (9). Consequently, physicians consider initiating ECMO for PARDS refractory to standard management when the risks of life-threatening hypoxemia, ventilator-induced lung injury, respiratory acidosis, and multiple organ failure are judged to be higher than the risks of bleeding, thrombosis, and other potential complications related to ECMO. Wide practice variations thus exist among centers regarding patient selection and more evidence on when to start ECMO, the risk factors for mortality, and general outcome data are needed.In this issue of Pediatric Critical Care Medicine, Watanabe et al (10) addressed some of these gaps by conducting a systematic review of 44 studies of 110 children supported on ECMO for COVID-19. Overall mortality was 27%. Of note, mortality appeared higher in children with MIS-C than with PARDS, even though the majority (82%) of children with MIS-C were previously healthy. While the study by Watanabe et al (10) was not designed to evaluate any potential survival benefit of ECMO over conventional therapy in pediatric COVID-19 patients or to assess when to initiate ECMO, several important details can be gleaned, nonetheless. First, ECMO survival of patients with PARDS from COVID-19 was higher than that of patients with PARDS from other causes, although this may have been affected by publication bias and other confounders. Second, survival in children was higher and complication rates were generally lower than those of adults receiving ECMO for . Third, the use of both corticosteroids *See also p. 406.

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Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

Khoury,

Harahsheh,

Raghuveer

et al. 2023

JAMA Netw Open

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ImportanceObesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.ObjectiveTo compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C.Design, Setting, and ParticipantsIn this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded.Main Outcomes and MeasuresPatient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI &lt;85th percentile), overweight (BMI ≥85th to &lt;95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups.ResultsOf 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P &lt; .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD.Conclusions and RelevanceIn this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.

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Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Cited by 10 publications

References 67 publications

Assessment of Efficacy and Safety of mRNA COVID-19 Vaccines in Children Aged 5 to 11 Years

Assessment of Efficacy and Safety of mRNA COVID-19 Vaccines in Children Aged 5 to 11 Years

Outcomes After Extracorporeal Membrane Oxygenation in Children With COVID-19*

Obesity and Outcomes of Kawasaki Disease and COVID-19–Related Multisystem Inflammatory Syndrome in Children

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