Mechanical Circulatory Support for Multisystem Inflammatory Syndrome in Children (MIS-C): A Single Center Case Series

Purpose: Multisystem inflammatory syndrome in children (MIS-C) is a rare but life-threatening complication of SARS-CoV-2 that is characterized by a hyperinflammatory state leading to multiorgan dysfunction. With prompt initiation of appropriate medical management, patients fair well with resolution of the hyperinflammatory state and recovery of end-organ function. However, a small subset of patients with MIS-C develop progressive end-organ dysfunction necessitating mechanical circulatory support (MCS). This case series describes a single center experience of MCS for MIS-C. Methods: This is a retrospective case series of patients diagnosed with MIS-C who required MCS between May 2020-February 2022 at Texas Children's Hospital. The study was conducted under institutional review board approval. Results: During the study period, 291 patients were diagnosed with MISC. Of those, 6 required MCS: 4 were placed on VAECMO with 1 patient additionally requiring a left ventricular assist device (LVAD), 1 required solely LVAD support, and 1 required VV-ECMO in the setting of pulmonary hemorrhage. In 5 of the 6 patients, the primary indication for MCS was a hemodynamically significant tachyarrythmia. Echocardiography showed worsening of global longitudinal strain (GLS) prior to cannulation in those patients in which it was measured. 5 of the 6 patients survived to hospital discharge. 2 patients required emergent fasciotomies and subsequent limb amputation. Immunomodulation with anakinra before MCS correlated with shorter intensive care length of stay. Outpatient follow-up was conducted in the MIS-C clinic, ranging from 1 to 15 months since discharge, with notable normalization of cardiac function and no additional adverse events. Conclusion: Overall, the need for MCS in patients diagnosed with MIS-C is uncommon and outcomes seem favorable. The development of tachyarrhythmias and worsening GLS may be risk factors for MCS. These findings need to be validated with larger, multicenter studies. Prospective studies of early therapeutic intervention in MIS-C are also needed.

Remote or Virtual Laboratory for HIL (Hardware-In-the-Loop) Testing Education

Due to the COVID-19 pandemic the education has to be undertaken virtually on digital platforms in Hungary and many other countries. This presented new challenges to our department at the Budapest University of Technology and Economics. Our education and primary its laboratory part was very hardware focused. This paper introduces our solution for educating model based embedded system development and HIL (Hardware-In-the-Loop) testing in a remote or virtual laboratory environment. The laboratory uses a racing car simulator as a platform. Using the measurements data gathered from the racing car simulator the students can create their own control algorithms (like speed controller, or automated steering) and modify the behavior of the car. The laboratory can be configured to a virtual setup, where just simulations, and models are used, or it also can be configured to a remote setup, where real hardware-s is used through a VNC interface based virtual desktop access. © 2022 IEEE.