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Cardiovascular sequelae from COVID-19: perspectives from a paediatric cardiac ICU

Part of: Infectious

Published online by Cambridge University Press:  24 February 2022

Javier J. Lasa*
Affiliation:
Division of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Alexander Alali
Affiliation:
Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Marc Anders
Affiliation:
Division of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Sebastian C. Tume
Affiliation:
Division of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Eyal Muscal
Affiliation:
Division of Rheumatology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
S. Kristen Sexson Tejtel
Affiliation:
Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
Lara Shekerdemian
Affiliation:
Division of Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: J. J. Lasa, MD, Associate Professor, Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Baylor College of Medicine, MC: E1420, 6651 Main Street, Houston, TX 77030, USA. Tel: (832) 826-0610; Fax: (832) 825-7422. E-mail: jjlasa@texaschildrens.org

Abstract

Objective:

Paediatric ICUs have shared the burden of the COVID-19 pandemic, including subspecialty cardiac ICUs. We sought to address knowledge gaps regarding patient characteristics, acuity, and sequelae of COVID-19 in the paediatric cardiac ICU setting.

Design:

Retrospective review of paediatric cardiac ICU admissions with COVID-19-related disease.

Setting:

Single centre tertiary care paediatric cardiac ICU.

Patients:

All patients with PCR/antibody evidence of primary COVID-19 infection, and/or Multisystem Inflammatory Syndrome in Children, were admitted between 26 March, 2020 and 31 March, 2021.

Interventions:

None.

Main outcomes measures:

Patient-level demographics, pre-existing conditions, clinical symptoms, and outcomes related to ICU admission were captured from medical records.

Results:

Among 1064 patients hospitalised with COVID-19/Multisystem Inflammatory Syndrome in Children, 102 patients (9.5%) were admitted to cardiac ICU, 76 of which were symptomatic (median age 12.5 years [IQR 7.5–16.0]). The primary system involved at presentation was cardiovascular in 48 (63%). Vasoactive infusions were required in 62% (n = 47), with eight patients (11%) requiring VA ECMO. Severity of disease was categorised as mild/moderate in 16 (21%) and severe/critical in 60 patients (79%). On univariate analysis, African-American race, presentation with gastrointestinal symptoms or elevated inflammatory markers were associated with risk for severe disease. All-cause death was observed in five patients (7%, n = 5/72) with four patients remaining hospitalised at the time of data query.

Conclusion:

COVID-19 and its cardiovascular sequelae were associated with important morbidity and significant mortality in a notable minority of paediatric patients admitted to a paediatric cardiac ICU. Further study is required to quantify the risk of morbidity and mortality for COVID-19 and sequelae.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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