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

ABSTRACT

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.