Hematologic characteristics of children with covid-19 in comparison with non covid patients on extracorporeal membrane oxygenation at a tertiary pediatric hospital

ABSTRACT

Severe acute respiratory distress syndrome (ARDS) due to COVID-19 continues to be a common cause of morbidity and mortality. Early reports showed a potential therapeutic benefit of extracorporeal membrane oxygenation (ECMO) for these patients. Our IRB-approved, retrospective study examined seven children with COVID 19 (0-18 years of age) placed on ECMO from March 2020 to April 2021. Three of the patients were on veno-venous ECMO;four on veno-arterial ECMO. While on ECMO, 5 of the 7 patients had hemorrhage, and 3 had thrombotic complications. The mortality rate was 28%. The median times from onset of symptoms to ECMO cannulation was 9 days, and from intubation to ECMO was 5 days. Five of the 7 patients received convalescent plasma and Remdesivir. We also identified seventeen non-cardiac, non-COVID ECMO patients as controls. The median ECMO duration for the COVID-19 (Cov) patients was 14 days. (controls 8 days) The median maximum heparin dose for the Cov patients was 25 units/kg/hour. (controls 24 units/kg/hr) The median maximum bivalirudin dose for the Cov group was 0.34 mg/kg/hr. (controls 0.46 mg/kg/hr) The median blood product transfusions per ECMO day for the Cov group were red cells (0.33;controls 0.55);platelets (0.67;controls 0.20);plasma (0.05;controls 0.09) and cryoprecipitate (0.13;controls 0). Other laboratory parameters examined were d dimer, red blood cells, white blood cells, platelets, and fibrinogen levels. There were clinical differences observed in anticoagulation and blood product usage between the COVID-19 and non COVID ECMO patients.