Acute heart failure in multisystem inflammatory syndrome in
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Physicians around the world have recently noted that a small number of children exposed to COVID-19 have an emerging condition with features overlapping toxic shock syndrome and similar to a heart condition known as Kawasaki disease, together with cardiac inflammation. In this small study, researchers in France and Switzerland retrospectively collected and analyzed clinical, biological, therapeutic and early outcome data for children admitted to the pediatric intensive care unit from March 22 to April 30, 2020, with fever, cardiogenic shock or acute left ventricular dysfunction with inflammatory state.

This analysis included 35 children (ages 2 to 16; median age of 10 years). Thirty-one (88.5%) children tested positive for SARS-CoV-2 infection, and none of the children had underlying cardiovascular disease. Secondary conditions were limited, and 17% of patients were overweight (n=6). All patients presented with fever and unusual lethargy (asthenia) lasting approximately 2 days, and 83% of patients (n=29) presented with gastrointestinal symptoms.

Left ventricular systolic dysfunction was present in all patients in association with low systolic blood pressure. Almost all patients required respiratory assistance (n= 33). Left ventricular function recovered in the majority of patients discharged from the intensive care unit (n=25). Ten patients treated with ECMO (extracorporeal membrane oxygenation) for 3-6 days were successfully weaned. (ECMO is a process whereby the blood is sent through a machine to increase the amount of oxygen in the blood. The oxygen-rich blood is then returned to the body.)

The majority of patients received intravenous immune globulin treatment (n=25), and 12 patients were treated with intravenous steroids. Three children were treated with an interleukin 1 receptor antagonist due to persistent severe inflammatory state. 23 patients were treated with a therapeutic dose of heparin. No deaths were observed.

“The majority of patients recovered within a few days following intravenous immune globulin, with adjunctive steroid therapy used in one third. Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function,” researchers reported.

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