Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs

Melania M Bembea; Laura L Loftis; Ravi R Thiagarajan; Cameron C Young; Timothy P McCadden; Margaret M Newhams; Suden Kucukak; Elizabeth H Mack; Julie C Fitzgerald; Courtney M Rowan; Aline B Maddux; Amanda R Kolmar; Katherine Irby; Sabrina Heidemann; Stephanie P Schwartz; Michele Kong; Hillary Crandall; Kevin M Havlin; Aalok R Singh; Jennifer E Schuster; Mark W Hall; Kari A Wellnitz; Mia Maamari; Mary G Gaspers; Ryan A Nofziger; Peter Paul C Lim; Ryan W Carroll; Alvaro Coronado Munoz; Tamara T Bradford; Melissa L Cullimore; Natasha B Halasa; Gwenn E McLaughlin; Pia S Pannaraj; Natalie Z Cvijanovich; Matt S Zinter; Bria M Coates; Steven M Horwitz; Charlotte V Hobbs; Heda Dapul; Ana Lia Graciano; Andrew D Butler; Manish M Patel; Laura D Zambrano; Angela P Campbell; Adrienne G Randolph; Overcoming COVID-19 Investigators

doi:10.1097/PCC.0000000000003212

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs

Pediatr Crit Care Med. 2023 May 1;24(5):356-371. doi: 10.1097/PCC.0000000000003212. Epub 2023 Mar 30.

Authors

Melania M Bembea¹, Laura L Loftis², Ravi R Thiagarajan³, Cameron C Young⁴, Timothy P McCadden⁴, Margaret M Newhams⁴, Suden Kucukak⁴, Elizabeth H Mack⁵, Julie C Fitzgerald⁶, Courtney M Rowan⁷, Aline B Maddux⁸, Amanda R Kolmar⁹, Katherine Irby¹⁰, Sabrina Heidemann¹¹, Stephanie P Schwartz¹², Michele Kong¹³, Hillary Crandall¹⁴, Kevin M Havlin¹⁵, Aalok R Singh¹⁶, Jennifer E Schuster¹⁷, Mark W Hall¹⁸, Kari A Wellnitz¹⁹, Mia Maamari²⁰, Mary G Gaspers²¹, Ryan A Nofziger²², Peter Paul C Lim²³, Ryan W Carroll²⁴, Alvaro Coronado Munoz²⁵, Tamara T Bradford²⁶, Melissa L Cullimore²⁷, Natasha B Halasa²⁸, Gwenn E McLaughlin²⁹, Pia S Pannaraj³⁰, Natalie Z Cvijanovich³¹, Matt S Zinter³², Bria M Coates³³, Steven M Horwitz³⁴, Charlotte V Hobbs³⁵, Heda Dapul³⁶, Ana Lia Graciano³⁷, Andrew D Butler³⁸, Manish M Patel³⁹, Laura D Zambrano³⁹, Angela P Campbell³⁹, Adrienne G Randolph^{4

40}; Overcoming COVID-19 Investigators

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
² Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
³ Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁴ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
⁵ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
⁶ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
⁸ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁹ Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
¹⁰ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR.
¹¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Central Michigan University, Detroit, MI.
¹² Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC.
¹³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
¹⁴ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT.
¹⁵ Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Louisville, and Norton Children's Hospital, Louisville, KY.
¹⁶ Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY.
¹⁷ Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO.
¹⁸ Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
¹⁹ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.
²⁰ Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children's Health Medical Center, Dallas, TX.
²¹ Department of Pediatrics and Banner Children's at Diamond Children's Medical Center, University of Arizona, Tucson, AZ.
²² Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, OH.
²³ Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH.
²⁴ Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA.
²⁵ Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX.
²⁶ Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, LA.
²⁷ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE.
²⁸ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
²⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL.
³⁰ Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles, CA.
³¹ Division of Critical Care Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA.
³² Department of Pediatrics, Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, University of California San Francisco, San Francisco, CA.
³³ Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
³⁴ Department of Pediatrics, Division of Pediatric Critical Care Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
³⁵ Department of Pediatrics, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS.
³⁶ Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, NY.
³⁷ Department of Pediatrics, Division of Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
³⁸ Division of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, PA.
³⁹ COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA.
⁴⁰ Departments of Anesthesia and Pediatrics, Harvard Medical School, Boston, MA.

Abstract

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Adult
COVID-19* / therapy
Child
Extracorporeal Membrane Oxygenation*
Hospitalization
Humans
Intensive Care Units
Retrospective Studies
SARS-CoV-2

Supplementary concepts

pediatric multisystem inflammatory disease, COVID-19 related
SARS-CoV-2 variants

Abstract

Publication types

MeSH terms

Supplementary concepts

Grants and funding