Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs
Creators: name: McLaughlin, G.E.
name: Rowan, C.M.
name: Loftis, L.L.
name: Young, C.C.
name: Carroll, R.W.
name: Zambrano, L.D.
name: Gaspers, M.G.
name: Wellnitz, K.A.
name: Thiagarajan, R.R.
name: Bembea, M.M.
name: Bradford, T.T.
name: Lim, P.P.C.
name: Havlin, K.M.
name: Singh, A.R.
name: Maamari, M.
name: Irby, K.
name: Schwartz, S.P.
name: Maddux, A.B.
name: Fitzgerald, J.C.
name: Crandall, H.
name: Dapul, H.
name: Graciano, A.L.
name: Cullimore, M.L.
name: Butler, A.D.
name: Kolmar, A.R.
name: McCadden, T.P.
name: Horwitz, S.M.
name: Hobbs, C.V.
name: Pannaraj, P.S.
name: Mack, E.H.
name: Munoz, A.C.
name: Cvijanovich, N.Z.
name: Zinter, M.S.
name: Nofziger, R.A.
name: Kong, M.
name: Coates, B.M.
name: Schuster, J.E.
name: Randolph, A.G.
name: Newhams, M.M.
name: Overcoming COVID-19 Investigators
name: Halasa, N.B.
name: Kucukak, S.
name: Patel, M.M.
name: Campbell, A.P.
name: Heidemann, S.
name: Hall, M.W.
Publisher: name: Lippincott Williams and Wilkins
Year: 2023

description: 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.