key: cord-0878938-vi8pisac
authors: Ebach, Fabian; Hainmann, Ina; Eis‐Hübinger, Anna M.; Escherisch, Gabriele; Dilloo, Dagmar; Reutter, Heiko M.; Müller, Andreas
title: Successful ECMO therapy in a child with COVID‐19‐associated ARDS and acute lymphoblastic leukemia
date: 2021-05-22
journal: Pediatr Blood Cancer
DOI: 10.1002/pbc.29100
sha: e1041f3abf4df4d3492fcff5030cfc547677c862
doc_id: 878938
cord_uid: vi8pisac

nan

To the Editor:

Since the first reports in January 2020, COVID-19 has evolved into a global pandemic and public health challenge. The vast majority of children and adolescents are found to exhibit mild symptoms or remain asymptomatic, even in the context of treatment for a malignant disease. 1 Most reports of extracorporeal membrane oxygenation (ECMO) therapy for severe SARS-CoV-2-associated pediatric acute respiratory distress syndrome (ARDS) involve immunocompetent older children or adolescents. 2, 3 Here, however, we report on successful ECMO therapy in a 2-year-old boy with acute lymphoblastic leukemia (ALL) and therapy-induced neutropenia.

After induction treatment according to the CoALL 08-09 trial, 4 the patient was stratified to the low-risk arm of the trial 4 On DOI 9, respiratory symptoms and hypoxemia worsened rapidly, and after short tentative respiratory support via high flow nasal cannula, the patient had to be intubated for mechanical ventilation. Inhalative nitric oxide and inotropic and vasopressor support were initiated for pulmonary hypertension and impaired right ventricular function.

After 1 week in aplasia, neutrophil counts rose again above 500/µl on DOI 12.

Required airway pressures continued to rise rapidly, so that the only remaining therapeutic option was veno-venous ECMO therapy on DOI 14 (see Table S1 ). Therapy with remdesivir was discontinued on DOI 16.

Hydrocortisone was initiated the next day based on the latest available German consensus guidelines 5 and our own experience with pediatric ARDS. Today, however, considering meanwhile published evidence, we would choose dexamethasone for anti-inflammatory treatment. 6 With improving gas exchange, we discontinued ECMO therapy on DOI 32. The patient was extubated on DOI 41, respiratory support via High-Flow nasal cannula was discontinued on DOI 50.

Despite a delay of chemotherapy of 6.5 weeks, neither cerebrospinal fluid nor bone marrow showed any signs of leukemia (minimal residual disease negative 7 ). RT-PCR for SARS-CoV-2 was repeatedly negative from DOI 55 onwards. Blood cultures and tracheal samples remained negative by culture and PCR for bacterial agents throughout the entire therapy. However, concerned about possible recurrence

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SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section at the end of the article