- Acute cardiac decompensation in pediatric COVID-19 is rare and could require fewer intensive interventions if caught sufficiently early.
- Authors: immunoglobulin and steroid treatment is associated with rapid left ventricular (LV) systolic function recovery.
- The condition is now being called multisystem inflammatory syndrome in children, or MIS-C.
Why this matters
- Authors: acute heart failure/cardiogenic shock seen with MIS-C is likely the result of myocardial stunning or edema as opposed to inflammatory damage to the myocardium.
- An algorithm implemented to support early capture seems to be working and reducing the proportion of severe cases.
- Median age at admission: 10 (range, 2-16) years.
- Time from first symptoms of MIS-C to heart failure: median, 6 days.
- Presentation: fever, weakness.
- Some had swollen lymph nodes, rash, other Kawasaki-like signs.
- Gastrointestinal manifestations (vomiting, diarrhea, pain) in 80%.
- Almost a third had LV ejection fraction
- 80% needed inotropic support for cardiogenic shock.
- 29% received extracorporeal membrane oxygenation (all successfully weaned).
- Inflammatory markers elevated, indicated cytokine storm.
- 89% SARS-CoV-2-positive.
- All received intravenous immunoglobulin; a third also received steroids.
- 25 of 35 had restored LV function at ICU discharge.
- No coronary aneurysms to date.
- No deaths, and all but 1 are discharged.
- Retrospective case series, 14 pediatric ICUs in France and Switzerland, March 22-April 30, 2020.
- Funding: None.
- Small, observational.