DISCUSSION
There are several reports of ECMO use in adult patients with coronavirus COVID-19 who develop ARDS9. Ramanathan et al. reported that the majority of patients received VV-ECMO support and that the mortality in these patients was 37.1%, similar to those with non-COVID-19-related ARDS.
Nevertheless, there are no systematic reviews or case series with a high number of pediatric patients who have required ECMO therapy. The European Chapter of the Extracorporeal Life Support Organization (ELSO) reported a case series of only 7 children that required ECMO from reports from 52 centers3. The majority required veno-arterial ECMO and only in 3 cases the indication for ECMO was hypoxemia. The mortality in this case series was 43%. Apart from this series, there are a few publications of isolated case reports of COVID-19 and ECMO in pediatric patients4-8. In them, the patients described are mainly adolescents, some with previous comorbidities. All the patients described in these case reports reviewed survived except one; however, thrombotic events were frequently reported despite use of anticoagulation protocols. While these events are common on ECMO, COVID-19 has been associated with the increase in the risk of thrombosis. For this reason, the ELSO guidelines recommend a close monitoring of coagulation, ideally based on thromboelastography10. Effectively, in the case of our patient, his main complication was a hemothorax, probably due to coagulation disorders aggravated by chemotherapy treatment.
Another important aspect of our patient and about which there is also little reported experience, is the use of chemotherapy during ECMO support. In the bibliographic review carried out, we only found a case report of a pediatric patient with a T-cell lymphoblastic lymphoma who received chemotherapy during ECMO support11. In that patient and in ours, we showed that successful chemotherapy can be administered while the patient is on ECMO support, despite underlying and nosocomial infections.