Extracorporeal Membrane Oxygenation for Pediatric Patients with Coronavirus Disease 2019-Related Illness∗

Robert M. MacGregor, Ryan M. Antiel, Tasnim Najaf, Ahmed S. Said, Brad W. Warner, Mehul V. Raval, Baddr Shakhsheer*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children's hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. Design: Confidential, self-administered questionnaire. Setting: One hundred twenty-seven U.S. pediatric extracorporeal membrane oxygenation centers. Subjects: Extracorporeal membrane oxygenation center program directors and coordinators. Interventions: None. Measurements and Main Results: In March 2020, a survey was sent to 127 pediatric extracorporeal membrane oxygenation centers asking them to report their current hospital extracorporeal membrane oxygenation guidelines for coronavirus disease 2019-positive patients. Respondents were also asked their opinion on three ethical dilemmas including: prioritization of children over adults for extracorporeal membrane oxygenation use, institution of do-not-resuscitate orders, and the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019-positive patients. Forty-seven extracorporeal membrane oxygenation centers had enacted guidelines including 46 (100%) that offer venovenous-extracorporeal membrane oxygenation and 42 (89%) that offer venoarterial-extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients. Forty-four centers (94%) stated that the indications for extracorporeal membrane oxygenation candidacy in coronavirus disease 2019 disease were similar to those used in other viral illnesses, such as respiratory syncytial virus or influenza. Most program directors (98%) did not endorse that children hospitalized with coronavirus disease 2019 should be made do-not-resuscitate and had variable opinions on whether children should be given higher priority over adults when rationing extracorporeal membrane oxygenation. Over half of program directors (60%) did not support the use of extracorporeal cardiopulmonary resuscitation for coronavirus disease 2019. Conclusions: The majority of pediatric extracorporeal membrane oxygenation centers have proactively established guidelines for the use of extracorporeal membrane oxygenation for coronavirus disease 2019-related illnesses. Further work is needed to help guide the fair allocation of extracorporeal membrane oxygenation resources and to determine the appropriateness of extracorporeal cardiopulmonary resuscitation.

Original languageEnglish (US)
Pages (from-to)893-897
Number of pages5
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • coronavirus
  • coronavirus disease 2019
  • do-not-resuscitate
  • extracorporeal cardiopulmonary resuscitation
  • extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

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