Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs*
Authors: Bembea Melania M. , Loftis Laura L. , Thiagarajan Ravi R. , Young Cameron C. , McCadden Timothy P. , Newhams Margaret M. , Kucukak Suden , Mack Elizabeth H. , Fitzgerald Julie C. , Rowan Courtney M. , Maddux Aline B. , Kolmar Amanda R. , Irby Katherine , Heidemann Sabrina , Schwartz Stephanie P. , Kong Michele , Crandall Hillary , Havlin Kevin M. , Singh Aalok R. , Schuster Jennifer E. , Hall Mark W. , Wellnitz Kari A. , Maamari Mia , Gaspers Mary G. , Nofziger Ryan A. , Lim Peter Paul C. , Carroll Ryan W. , Coronado Munoz Alvaro , Bradford Tamara T. , Cullimore Melissa L. , Halasa Natasha B. , McLaughlin Gwenn E. , Pannaraj Pia S. , Cvijanovich Natalie Z. , Zinter Matt S. , Coates Bria M. , Horwitz Steven M. , Hobbs Charlotte V. , Dapul Heda , Graciano Ana Lia , Butler Andrew D. , Patel Manish M. , Zambrano Laura D. , Campbell Angela P. , Randolph Adrienne G. ,   on behalf of the Overcoming COVID-19 Investigators
Published: March 2023

OBJECTIVES:
Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2–related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed.

DESIGN:
Case series of patients from the Overcoming COVID-19 public health surveillance registry.

SETTING:
Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021.

PATIENTS:
Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The final cohort included 2,733 patients with MIS-C (n = 1,530; 37 [2.4%] requiring ECMO) or acute COVID-19 (n = 1,203; 71 [5.9%] requiring ECMO). ECMO patients in both groups were older than those without ECMO support (MIS-C median 15.4 vs 9.9 yr; acute COVID-19 median 15.3 vs 13.6 yr). The body mass index percentile was similar in the MIS-C ECMO versus no ECMO groups (89.9 vs 85.8; p = 0.22) but higher in the COVID-19 ECMO versus no ECMO groups (98.3 vs 96.5; p = 0.03). Patients on ECMO with MIS-C versus COVID-19 were supported more often with venoarterial ECMO (92% vs 41%) for primary cardiac indications (87% vs 23%), had ECMO initiated earlier (median 1 vs 5 d from hospitalization), shorter ECMO courses (median 3.9 vs 14 d), shorter hospital length of stay (median 20 vs 52 d), lower in-hospital mortality (27% vs 37%), and less major morbidity at discharge in survivors (new tracheostomy, oxygen or mechanical ventilation need or neurologic deficit; 0% vs 11%, 0% vs 20%, and 8% vs 15%, respectively). Most patients with MIS-C requiring ECMO support (87%) were admitted during the pre-Delta (variant B.1.617.2) period, while most patients with acute COVID-19 requiring ECMO support (70%) were admitted during the Delta variant period.

CONCLUSIONS:
ECMO support for SARS-CoV-2–related critical illness was uncommon, but type, initiation, and duration of ECMO use in MIS-C and acute COVID-19 were markedly different. Like pre-pandemic pediatric ECMO cohorts, most patients survived to hospital discharge.