Holding on to life with ECMO in severe multisystem inflammatory syndrome in children (MIS-C)

ABSTRACT

Objective: MIS-C is a rare hyperinflammatory syndrome requiring intensive care due to severe cardiovascular effects associated with COVID 19. It has been reported that 68% of the patients need intensive care, while about 4% need extracorporeal membrane oxygenation (ECMO). The mortality rate of cases developing ECMO need has been reported as 22.5%. Methods: We reported a patient who developed a need for ECMO with a diagnosis of severe MIS-C and who was successfully weaned from ECMO. Results: Herein we present a 14.5-year-old female patient who was diagnosed with MIS-C because of fever, diarrhea, and COVID 19 antibody positivity. Inotrope treatments were started immediately after the development of fluid-resistant hypotension. Plasma exchange, IVIG, pulse steroid and anakinra treatments for immunomodulation were started. Vasoactive inotrope score of the patients was 42 and ejection fraction was 20% in echocardiography. Despite inotropic support and immunomodulatory treatment hypotension and hyperlactatemia were persisted and patient was put on V-A ECMO on the 3rd day of hospital admission. Second session of plasma exchange was applied to the patient after initiation of ECMO support. Functions of right and left ventricle were improved and inflammatory parameters were decreased under ECMO support. Patient was weaned from ECMO and decannulated on the 6th day of ECMO support. No ECMO complications occurred. Patient was extubated on the 10th day of admission and the patient was supported with noninvasive mechanical ventilation for 3 days. Physiotherapy was initiated because of critical illness myopathy. The patient was discharged with full recovery on the 25th day of hospitalization. Conclusions: ECMO should always be kept in mind as a support method that can bridge recovery in severe MISC patients.