Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2023 May 1;24(5):356-371. doi: 10.1097/PCC.0000000000003212. Epub 2023 Mar 30.
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.
Case series of patients from the Overcoming COVID-19 public health surveillance registry.
Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021.
Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19.
None.
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.
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.
体外膜肺氧合（ECMO）已成功用于支持对常规治疗无效的严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）相关心脏或呼吸衰竭的成人。需要综合报告儿童和青少年接受 SARS-CoV-2 相关 ECMO 支持的情况，包括儿童多系统炎症综合征（MIS-C）和急性 COVID-19。
来自克服 COVID-19 公共卫生监测登记处的患者病例系列。
32 个美国州的 63 家报告该登记处的医院，报告时间为 2020 年 3 月 15 日至 2021 年 12 月 31 日。
入住 ICU 并符合疾病控制中心关于 MIS-C 或急性 COVID-19 标准的年龄小于 21 岁的患者。
无。
最终队列包括 2733 名患有 MIS-C（n=1530；37[2.4%]需要 ECMO）或急性 COVID-19（n=1203；71[5.9%]需要 ECMO）的患者。两组中接受 ECMO 治疗的患者比未接受 ECMO 支持的患者年龄更大（MIS-C 中位数 15.4 岁 vs 9.9 岁；急性 COVID-19 中位数 15.3 岁 vs 13.6 岁）。MIS-C ECMO 组与无 ECMO 组的体重指数百分位数相似（89.9% vs 85.8%；p=0.22），但 COVID-19 ECMO 组的体重指数百分位数较高（98.3% vs 96.5%；p=0.03）。与 COVID-19 相比，患有 MIS-C 并接受 ECMO 治疗的患者更常接受静脉动脉 ECMO（92% vs 41%）用于主要心脏指征（87% vs 23%），更早开始 ECMO（中位数从住院到开始 ECMO 的时间为 1 天 vs 5 天），ECMO 疗程更短（中位数 3.9 天 vs 14 天），住院时间更短（中位数 20 天 vs 52 天），院内死亡率更低（27% vs 37%），幸存者出院时主要发病率更低（新气管造口术、需要氧气或机械通气或神经功能缺损；0% vs 11%、0% vs 20%和 8% vs 15%）。需要 ECMO 支持的大多数 MIS-C 患者（87%）是在 Delta（变体 B.1.617.2）之前入院的，而需要 ECMO 支持的大多数急性 COVID-19 患者（70%）是在 Delta 变体时期入院的。
SARS-CoV-2 相关危急疾病的 ECMO 支持并不常见，但 MIS-C 和急性 COVID-19 中 ECMO 的类型、启动和持续时间明显不同。与大流行前的儿科 ECMO 队列一样，大多数患者存活至出院。
