Ecmo utilization in multisystem inflammatory syndrome in children (mis-c)

ABSTRACT

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is an entity described in children after infection with SARS-CoV-2. Current literature reports wide variability of extracorporeal membrane oxygenation (ECMO) utilization (2-28%) and mortality (0-28%). Details of the ECMO course, including duration, complications, and outcomes have been limited. We present a case series of 5 patients successfully managed with ECMO for MIS-C. Methods: A retrospective chart review of all patients requiring ECMO for MIS-C was performed at a single center tertiary pediatric institution between June 2020 and March 2021. Demographics, complications, and outcomes were analyzed. Results: Five patients required ECMO (median age 12.6 years, range 4-17). Venoarterial ECMO (5/5) was initiated for acute decompensated heart failure (n=4) or arrhythmia (n=1) with 2/5 patients requiring ECPR. Median ECMO duration was 6 days. Anticoagulation included heparin only (n=2), direct thrombin inhibitor only (n=1), or combination (n=2). ECMO courses were complicated by extensive systemic thrombosis in 1/5, intracardiac thrombus in 3/5, compartment syndrome requiring fasciotomy in 1 (complete recovery of limb function). Tissue plasminogen activator (t-PA) was utilized for extensive thrombosis in 2/5 patients. All patients survived to hospital discharge with excellent neurologic outcomes. Cardiac function normalized in 5/5 patients with only moderate mitral regurgitation in 1 patient. Conclusion: ECMO can be successfully employed to support cardiac function in patients with MIS-C. Anticoagulation in this population remains challenging with thrombotic complications being common;however, outcomes are encouraging with 100% survival in this case series with complete recovery of cardiac function and return to neurologic baseline.