ABSTRACT
Objective: The successful use of ECMO in adult patients with severe respiratory failure from COVID-19 has been reported, but there is little data in children or adolescents except those with cardiac manifestations. Thus, the utility of ECMO in pediatric patients with severe respiratory failure is not well established. Describe the clinical course and outcome of three pediatric patients with COVID-19 who progressed to Acute Respiratory Distress Syndrome (ARDS) requiring ECMO. Methods: Data related to demographics, clinical course, ECMO course and outcome from three consecutive pediatric patients who received venovenous (VV) ECMO due to COVID-19-associated respiratory failure were analyzed from electronic health records. IRB approval was given. Results: We describe three patients (see Figure 1) aged 14 to 16 who all had acute COVID-19 leading to the acute respiratory distress syndrome - one patient whose father died from COVID following ECMO and two brothers. The patients presented between days 4 and 10 of symptoms and rapidly required escalation of care including intubation, nitric oxide and VV ECMO. All three patients were treated with methylprednisolone, though with differing regimens;two received remdesivir through a clinical trial;and two required tracheostomy placement for respiratory support, with one having the tracheostomy tube removed prior to discharge. ECMO was continued for 9 to 24 days, with no episodes of recannulation, major bleeding events or other complications from the ECMO therapy. All three patients were eventually discharged;two were discharged home and one transferred to acute rehabilitation. Conclusions: These cases show the safe and effective use of VV ECMO in COVID-19-associated ARDS. Pediatric critical care physicians should be aware of the ability to use VV ECMO for pulmonary support in patients with COVID-19 illness and should consider early transfer to ECMO capable units to improve survival from ARDS related mortality.