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A2021 - Status Asthmaticus Requiring ECMO Associated with Rhinovirus Infection
Author Block: L. Greenawald1, A. Strang1, A. Chidekel1, C. Froehlich2; 1Pediatric Pulmonary Medicine, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, United States, 2Pediatric Critical Care Medicine, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, United States.
RATIONALE: Asthma is the most common chronic disease of childhood with exacerbations frequently triggered by viral illness. Human Rhinovirus (HRV) is a common cause of status asthmaticus (SA). This case series reviews five admissions in 4 pediatric patients who developed HRV-associated SA requiring Extracorporeal Membrane Oxygenation (ECMO). METHODS: The charts of 4 asthmatic patients (totaling five episodes of ECMO) were reviewed in this IRB-approved case series. Outcomes assessed included demographic information, past medical history, clinical parameters and spirometry. RESULTS: Patients (3M, 1F) had a mean age of 9 yrs. (range 7-12 yrs.) at the time of ICU admission. All were African American and carried a diagnosis of persistent asthma, documented as poorly controlled with non-adherence to prescribed, daily controller medications. All patients had Medicaid insurance. Passive smoke exposure occurred in 1 patient. Seasonal allergic rhinitis was diagnosed in ¾, with a mean IgE of 734 (range 12-2497). Frequent ER visits were documented in 3 of 4. All patients had previous hospitalizations with the majority (3/4) having one past admission to the ICU. Cases occurred in late spring (3/5) and fall (2/5). Severe respiratory (4/5) or metabolic acidosis (1/5) was documented, and HRV (+) viral illness was confirmed by PCR testing (4/5) or nasopharyngeal culture (1/5). V/V ECMO (4/5) or V/A ECMO (1/5) was continued for a mean duration of 4.2 days (range 3-7 days). During this time, all patients received short-acting bronchodilators, ipratropium, glucocorticoids, terbutaline and broad-spectrum antibiotics. All patients were discharged on ICS/LABA therapy. Spirometry was performed (4/5 cases) after hospitalization with a mean FEV1 of 1.59L (81 % predicted, range 69-91%), and an FEF 25-75% 1.13L (47.5% predicted, range 41-65%) at an average of 16.7 wks. post ECMO. CONCLUSION: This case series reviews a link between persistent, poorly controlled asthma and life-threatening SA due to rhinovirus infection. Current research highlights HRV as a lower respiratory tract infection that often results in prolonged hospitalization and readmission, particularly in children with asthma or atopy. Surprisingly, despite life-threatening illness, these patients did not demonstrate severe obstructive lung disease in the months following infection. Our understanding of the virulence of HRV continues to grow with a goal to prevent severe or even fatal illness in the pediatric population.