ABSTRACT
Purpose: The global COVID-19 pandemic has significantly altered delivery of healthcare. Hospital resource utilization has been impacted on multiple levels including solid organ transplantation and overall access to transplant care. In the United States, significant regional variation and decreased living donor transplantation occurred during the initial 6 months of the pandemic. We examined the multi-year impact of COVID-19 on pediatric organ donation and transplantation. Method(s): Pediatric (<18 years of age) organ donation and transplant data was obtained from the Organ Procurement and Transplantation Network (OPTN). Data included pediatric donors after brain death (pDBD), donors after circulatory death (pDCD), living donors (LD), and recipient details including total number of transplants, waitlist deaths, and removals were reviewed between January 2019 to December 2021. Result(s): Total pediatric transplants performed in 2019, 2020, and 2021 were 1923, 1766, and 1890 (p=0.004) respectively. Organ specific data is outlined in Table 1. In 2019, 2020, and 2021, living donor transplantation accounted for 320, 288, and 311 (p=0.838) cases, while 1579, 1456, and 1552 (p=<0.0001) deceased donor allografts were utilized. There were 171, 176, and 209 pDCD and 746, 684, and 713 pediatric pDBD donors. Living donors across all recipient ages were 7391, 5725, and 6539. 2392, 2337, and 2430 pediatric patients were added to all organ waitlists during the study period. 2347, 2198, and 2288 children were removed from the waitlist with 93, 82, and 76 of those cases due to patient death. There was no statistically significant difference in the proportion of pediatric patients added to the waitlist vs those removed during 2019-2021 (p=0.505) Conclusion(s): Transplant volume transiently decreased in the first six months of the COVID-19 pandemic. However, transplantation rates in children, specifically abdominal organ transplantation, increased to nearly pre-pandemic levels in 2021. Lung transplants were significantly decreased during the study period. Pediatric donation remained relatively steady from 2019-2021. Living donor transplantation in children was significantly impacted in 2020. Waitlist additions/removals remained consistent throughout the study period. (Table Presented).
ABSTRACT
Introduction: Children diagnosed with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C) can have rapid clinical deterioration and may require emergent hemodynamic and respiratory support with Extracorporeal Membrane Oxygenation (ECMO). Wolfson Children's Hospital (WCH) is the only free standing children's hospital in Northeast Florida. The 20 bed Pediatric Intensive Care Unit (PICU) averages 1100 admissions per year and is a level 1 trauma center. During the most recent wave of COVID, our hospital saw significantly increased numbers of children with COVID-19 and MIS-C requiring hospitalization and medical treatment in the PICU. The ECMO team at WCH was consulted for initiation of ECMO on several critically ill children with COVID-19 and MIS-C. Some children required extracorporeal cardiopulmonary resuscitation (ECPR). Many of these patients had significant obesity and other co-morbidities complicating patient management including emergent cannulation for ECMO. Cannulating a patient for ECMO during active CPR has poor outcomes that can be further impacted by obesity and an inability to generate adequate blood flow through smaller vessels in obese children. Therefore, our center sought to evaluate patients earlier for ECMO and attempt to avoid ECPR or emergent cannulation. A daily rounding checklist for COVID-19 and MIS-C patients was developed and implemented with a goal of preventing delayed care and enhancing efficient communication among all members of the healthcare team. Purpose: The ECMO team and physician leadership developed a daily rounding checklist to enhance communication with the interdisciplinary team for all COVID-19 and MIS-C patients admitted to the PICU. The checklist is completed by the ECMO Coordinator upon admission for children requiring respiratory and hemodynamic support with daily updates by the ECMO team coordinators, pediatric intensivist, and pediatric surgeon. The checklist ensures that each patient admitted to the PICU with COVID-19 or MIS-C has the following patient information, laboratory and imaging studies documented in the event the patient rapidly deteriorates and requires emergent cannulation for ECMO. Checklist information includes: patient weight, BMI, co-morbidities, cardiac echocardiogram to evaluate cardiac function, ultrasound of neck and femoral vessels to determine cannula size, head ultrasound (if applicable), patient's current condition (improving, unchanged, or deteriorating), type and cross, and candidacy for ECMO. The checklist allows all members of the healthcare team to have pertinent patient information readily available allowing expedited initiation of ECMO if needed. Implementation: The ECMO Coordinator consults with the attending pediatric intensivist and pediatric surgeon daily. Once the rounding checklist is completed, it is updated daily. If any items have not been completed, the ECMO coordinator recommends completion of missing testing or laboratory studies to the ICU team. Information gained from the ECMO Coordinator rounds is then added to the checklist and distributed to physician leadership, the PICU attending, ECMO medical directors, and the pediatric surgical team. If candidacy of a patient for ECMO is questionable, discussion occurs with the pediatric intensivist, pediatric surgeon, and ECMO medical directors to determine ECMO suitability. For high-risk patients, a primed circuit and catheters are available at the bedside with the ECMO team on standby. Outcomes: The implementation and utilization of this checklist has streamlined the process to determine suitability of children with COVID-19 and MIS-C that may require ECMO support at WCH. The process has enhanced patient care allowing a primed circuit, appropriate sized catheters, and discussion with the cardiovascular team in the event that thoracic cannulation may be required. This checklist is now being utilized for all patients that may require ECMO support allowing improved communication and collaboration between the pediatric intensivists, surgical group, and ECMO team.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has resulted in global pandemic. There is currently no effective therapeutic strategy for the management of mechanical ventilation or antiviral drugs for the treatment of this disease. As such, the development of a therapeutic strategy is urgently needed and should be established as soon as possible. In this case series, a therapeutic strategy was initially developed based on previous treatment methods used for the treatment of SARS and MERS in the absence of treatment options for COVID-19 due to a lack of information. During the search for a potential treatment, clinical findings were obtained from patients with severe COVID-19, and one therapeutic strategy was established. This therapeutic strategy was then applied to severe COVID-19 patients. In addition, we can require some interesting clinical features and characteristics of COVID-19 from blood analysis and physical findings. Here, we reported on the clinical features and characteristics of a therapeutic strategy for the treatment of severe COVID-19 pneumonia at our institution.