During the first wave of the COVID-19 pandemic, the European Extracorporeal Life Support Organization (ELSO) established a prospective survey including 52 European neonatal and paediatric centres and reported the use of extracorporeal membrane oxygenation (ECMO) in seven children with acute respiratory distress syndrome (ARDS) related to COVID-19 and paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS; also known as multisystem inflammatory syndrome in children). All European neonatal and paediatric ECMO centres affiliated with ELSO were included in the survey. Non-ELSO centres were also invited and included as representation for neonatal and paediatric ECMO centres in their respective country. The study was approved by the Maastricht University Ethical Committee (the coordinating centre) and registered at ClinicalTrials.gov (NCT04366921). Data were collected once per week and were reported as anonymised and deidentified using password-protected datasheets, and hence individual parent and patient consent was waived.
This survey highlighted the low use of ECMO in children compared with adults,(seven children vs 1531 adults), with similar survival to hospital discharge rates (57% in children vs 55% in adults).
The survey continued to capture contemporaneous data on ECMO use during the second and third waves of the pandemic, which we report now. Between July, 2020 and December, 2021, 24 children (<18 years) from nine countries (appendix p 1) were supported with ECMO for COVID-19. The predominant indication for ECMO was severe ARDS (n=18, 75%) followed by shock associated with PIMS-TS (n=5, 21%) and COVID-19 myocarditis (n=1, 4%). The median age was 9 years (range 11 days to 17 years) and 13 children (54%) had comorbidities. Comorbidities were more prevalent in children with ARDS than with PIMS-TS (appendix p2). The median time from the onset of symptoms to ECMO was 8·5 days (IQR 6·3–16·3, range 2–49) and it was not significantly different between children with ARDS and PIMS-TS (9·5 [6·5–17·3] in ARDS vs 7·0 [6·5–14·5] in PIMS-TS; Mann-Whitney U test p=0·59).