60-Extracorporeal Membrane Support for Pediatric Multisystem Inflammatory Syndrome in Children
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Pediatrics, Procedures, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Jordan Schneider

Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 (SARS-CoV-2) has been described in the pediatric population. These children present with symptomatology similar to Kawasaki disease/toxic shock syndrome with tachycardia, fever, hypotension, rash, abdominal pain, and depressed myocardial function. Treatment varies, with most centers describing supportive care and isolated reports of extracorporeal support. We present three cases of severe MIS-C with cardiogenic shock treated with venoarterial ECMO with excellent results.

Description: We report three cases of MIS-C with myocardial involvement in previously healthy children, all of whom were SARS-CoV-2 IgG positive. Patient 1, a 6 year old female, suffered a cardiac arrest prior to cannulation. All three patients had severely depressed myocardial function and arrhythmia, as well as evidence of multiple organ failure with severely elevated systemic inflammatory markers. The children were treated with intravenous immunoglobulin (IVIG), remdesivir, and methylprednisolone. Two patients received infliximab, while the other received tocilizumab. Patients 1 and 2 had features of Kawasaki disease, with significant coronary artery dilatation on echocardiogram, so were treated with moderate dose aspirin. Of note, Patients 1 and 2 were treated with aspirin prior to cannulation and were successfully anticoagulated using unfractionated heparin without clotting issues. Patient 3 did not have coronary dilation on echocardiogram, so was not treated with aspirin. Patient 3 had heparin resistance and developed clots in the arterial cannula within hours of initiation, requiring a circuit change and transition to bivalirudin for anticoagulation. All three patients had significant improvement in cardiac function within 48 hours after ECMO initiation, and all were decannulated and discharged home without serious sequelae. All three patients now have normal cardiac function on echocardiography and no residual end organ effects.

Discussion: This case series highlights a novel severe clinical presentation of COVID-19 in pediatric patients. These cases describe the successful use of ECMO to support children with MIS-C and treat the underlying inflammatory response with complete symptom resolution and normalization of cardiac function


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Procedures
Knowledge Level Advanced
Membership Level Select
Tag Extracorporeal Membrane Oxygenation ECMO
Tag Cardiothoracic Critical Care
Year 2021
extracorporeal membrane support
multisystem inflammatory syndrome in children
veno-arterial extracorporeal membrane oxygenation


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