Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in Children

Authors

  • Cristina Gago Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa.; Pediatric Functional Unit. Children Department. Hospital de Cascais Dr. José de Almeida. Cascais. Portugal. https://orcid.org/0000-0001-8516-8432
  • Cristina Lorenzo Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal.
  • Sara Pinto Pediatric Intensive Care Unit; Pediatric Infectious Diseases and Immunodeficiencies Unit.. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte.
  • Ana R. Sousa Pediatric Cardiology Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal.
  • Cristina Camilo Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal.
  • Francisco Abecasis Pediatric Intensive Care Unit. Department of Pediatrics. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal.

DOI:

https://doi.org/10.20344/amp.19053

Keywords:

Adolescent, COVID-19/complications, Extracorporeal Membrane Oxygenation, SARS-CoV-2, Shock, Cardiogenic, Systemic Inflammatory Response Syndrome

Abstract

Multisystem inflammatory syndrome in children is a rare and potentially life-threatening disease that is associated with SARS-CoV-2 infection, characterized by hyperinflammation and multiorgan involvement. Cardiovascular involvement is common, including myocardial dysfunction often leading to cardiogenic shock. We present the case of a 17-year-old boy with fever, odynophagia, maculopapular rash and abdominal pain who developed a cardiogenic shock. Due to progressive deterioration of cardiac function despite optimized vasoactive support, veno-arterial extracorporeal membrane oxygenation support was initiated 12 hours after admission, with successful decannulation after seven days and discharge after 23 days, with normal cardiac function. The patient received corticosteroids and intravenous immunoglobulin. Early recognition and intensive care support are crucial for ensuring a successful outcome in severe cases of multisystem inflammatory syndrome. In cases of severe cardiogenic shock, extracorporeal membrane oxygenation support can be critical for survival and rapid recovery.

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References

Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in china. Pediatrics. 2020;145:e20200702. DOI: https://doi.org/10.1542/peds.2020-0702

Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39:e340-6. DOI: https://doi.org/10.1097/INF.0000000000002888

Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe acute respiratory syndrome coronavirus 2 (sars-cov-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020;174:882-9. DOI: https://doi.org/10.1001/jamapediatrics.2020.1467

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MB, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334-46. DOI: https://doi.org/10.1056/NEJMoa2021680

Yasuhara J, Watanabe K, Takagi H, Sumitomo N, Kuno T. COVID-19 and multisystem inflammatory syndrome in children: a systematic review and metaanalysis. Pediatr Pulmonol. 2021;56:837-48. DOI: https://doi.org/10.1002/ppul.25245

Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020;4:669-77. DOI: https://doi.org/10.1016/S2352-4642(20)30215-7

Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global sars-cov-2 pandemic. Circulation. 2020;142:429-36. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.048360

Sperotto F, Friedman KG, Son MB, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in sars-cov-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2021;180:307-22. DOI: https://doi.org/10.1007/s00431-020-03766-6

Alsaied T, Tremoulet AH, Burns JC, Saidi A, Dionne A, Lang SM, et al. Review of cardiac involvement in multisystem inflammatory syndrome in children. Circulation. 2021;143:78-88. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.049836

Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, et al. Acute Cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation. 2021;143:21-32. DOI: https://doi.org/10.2139/ssrn.3634853

Badulak J, Antonini MV, Stead CM, Shekerdemian L, Raman L, Paden ML, et al. Extracorporeal membrane oxygenation for COVID-19: updated 2021 guidelines from the Extracorporeal Life Support Organization. ASAIO J. 2021;67:485-95. DOI: https://doi.org/10.1097/MAT.0000000000001422

Di Nardo M, Hoskote A, Thiruchelvam T, Lillie J, Horan M, Belda Hofheinz S, et al. Extracorporeal membrane oxygenation in children with coronavirus disease 2019: preliminary report from the collaborative european chapter of the Extracorporeal Life Support Organization prospective survey. ASAIO J. 2021;67:121-4. DOI: https://doi.org/10.1097/MAT.0000000000001309

Schwartz SP, Walker TC, Kihlstrom M, Isani M, Smith MM, Smith RL, et al. Extracorporeal membrane oxygenation for COVID-19-associated multisystem inflammatory syndrome in a 5-year-old. Am Surg. 2022;88:174-6. DOI: https://doi.org/10.1177/0003134820983198

Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with sars-cov-2. JAMA. 2020;324:259-69. DOI: https://doi.org/10.1001/jama.2020.10369

Royal College of Paediatrics and Child Health. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19. 2020. [cited 2021 Dec 11]. Available from: https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance.

World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. 2020. [cited 2021 Dec 11]. Available from: https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.

Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). [cited 2021 Dec 11]. Available from: https://emergency.cdc.gov/han/2020/han00432.asp.

McArdle AJ, Vito O, Patel O, Seaby EG, Shah P, Wilson C, et al. Treatment of multisystem inflammatory syndrome in children. N Engl J Med. 2021;385:11-22. DOI: https://doi.org/10.1056/NEJMoa2102968

RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19(RECOVERY): a randomised, controlled, open-label, platform Trial. Lancet. 2021;397:1637-45. DOI: https://doi.org/10.1016/S0140-6736(21)00676-0

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Published

2023-04-26

How to Cite

1.
Gago C, Lorenzo C, Pinto S, R. Sousa A, Camilo C, Abecasis F. Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in Children. Acta Med Port [Internet]. 2023 Apr. 26 [cited 2024 Apr. 28];36(11):740-5. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19053

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Section

Case Report