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

• Published in: Cardiology in the young Vol. 33; no. 1; pp. 52 - 59
• Main Authors: Lasa, Javier J., Alali, Alexander, Anders, Marc, Tume, Sebastian C., Muscal, Eyal, Tejtel, S. Kristen Sexson, Shekerdemian, Lara
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.01.2023
• Subjects: Acuity; Age; Antibodies; Asymptomatic; Cardiac arrhythmia; Cardiovascular disease; Clinical outcomes; Complications; COVID-19; Demographics; Dyspnea; Emergency medical care; Fever; Gastrointestinal symptoms; Health risks; Heart diseases; Hospitalization; Hospitals; Infections; Inflammation; Intensive Care; Laboratories; Medical records; Morbidity; Mortality; Multisystem inflammatory syndrome in children; Original Article; Ostomy; Pandemics; Patients; Pediatrics; Pneumonia; Respiratory failure; Severe acute respiratory syndrome coronavirus 2; Vasoactive agents; Ventilators; Viral diseases; United States > US; Texas; COVID-19; MIS-C; intensive care; cardiac ICU; paediatric
• ISSN: 1047-9511; 1467-1107; 1467-1107
• DOI: 10.1017/S1047951122000130

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. Retrospective review of paediatric cardiac ICU admissions with COVID-19-related disease. Single centre tertiary care paediatric cardiac ICU. 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. None. Patient-level demographics, pre-existing conditions, clinical symptoms, and outcomes related to ICU admission were captured from medical records. 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. 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.