DISCUSSION
There are several reports of ECMO use in adult patients with coronavirus
COVID-19 who develop ARDS9. Ramanathan et al. reported
that the majority of patients received VV-ECMO support and that the
mortality in these patients was 37.1%, similar to those with
non-COVID-19-related ARDS.
Nevertheless, there are no systematic reviews or case series with a high
number of pediatric patients who have required ECMO therapy. The
European Chapter of the Extracorporeal Life Support Organization (ELSO)
reported a case series of only 7 children that required ECMO from
reports from 52 centers3. The majority required
veno-arterial ECMO and only in 3 cases the indication for ECMO was
hypoxemia. The mortality in this case series was 43%. Apart from this
series, there are a few publications of isolated case reports of
COVID-19 and ECMO in pediatric patients4-8. In them,
the patients described are mainly adolescents, some with previous
comorbidities. All the patients described in these case reports reviewed
survived except one; however, thrombotic events were frequently reported
despite use of anticoagulation protocols. While these events are common
on ECMO, COVID-19 has been associated with the increase in the risk of
thrombosis. For this reason, the ELSO guidelines recommend a close
monitoring of coagulation, ideally based on
thromboelastography10. Effectively, in the case of our
patient, his main complication was a hemothorax, probably due to
coagulation disorders aggravated by chemotherapy treatment.
Another important aspect of our patient and about which there is also
little reported experience, is the use of chemotherapy during ECMO
support. In the bibliographic review carried out, we only found a case
report of a pediatric patient with a T-cell lymphoblastic lymphoma who
received chemotherapy during ECMO support11. In that
patient and in ours, we showed that successful chemotherapy can be
administered while the patient is on ECMO support, despite underlying
and nosocomial infections.