KOCHI: Adhik, 11, diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C), has fought the disease and swung back to life, after a critical battle. He was suffering from severe heart failure and shock due to MIS-C. Hailing from Kedamangalam, Paravur in Ernakulam district, Adhik is one of the rare patients to be put on ECMO (Extra Corporeal Membrane Oxygenation) for MIS-C.
Doctors have warned of a wave of MIS-C across South India, which will affect children in a big way. Adhik's case is an early warning, they said.
Adhik was treated at the Amrita Hospital in Kochi with ECMO, which is akin to the heart-lung bypass machine used in open-heart surgery, and saving his life from the dreaded disease that appears to be linked to Covid-19.
Being asymptomatic for Covid-19, Adhik was admitted to Amrita Hospital on June 13 in a serious condition. MIS-C had severely affected his heart muscles, which were inflamed and unable to pump blood. As per doctors who treated him, his blood pressure had dropped to extremely low levels and the condition would have turned fatal, if not treated promptly. On arrival at the hospital, the main challenge was that the child was in very severe shock and not responding, despite being on a ventilator and being given medications to improve his condition. Doctors at Amrita put him on ventilator support without delay.
“Putting a very sick child with low blood pressure and poor heart on ventilator needs a high degree of skill. The child required special lines to be inserted into his veins, so that medicines to elevate his blood pressure could be safely administered without needing to prick him all the time. A line was also inserted in a peripheral artery to help monitor his blood pressure accurately," said Dr Suma Balan, consultant paediatrician and paediatric rheumatologist at Amrita.
"A bedside echocardiogram was also arranged due to the severity of the child’s illness. However, the team realized that the child needed more medical attention and it was decided that an ECMO would help his recovery. This machine takes over the heart-lung function. Putting the child on ECMO for a few days allowed rest to his heart muscles, giving them time to recover. This works very well in scenarios where there is a good possibility of natural recovery – and Adhik’s situation fit that bill," said Dr Sajith Kesavan, head of paediatric pulmonary and critical care at the hospital.
ECMO pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest. When a patient is connected to an ECMO, blood flows through tubing into an artificial lung in the machine that adds oxygen and takes out carbon dioxide; then the blood is warmed to body temperature and pumped back into the body.
Since Adhik belonged to a middle-class family, affording the treatment was a big question mark to his parents. “The intensive care, immunomodulant therapy and the addition of ECMO increases treatment cost significantly, but the doctors knew that this offered Adhik the best chance for recovery. So, we were able to help them with some funding, and the family raised the rest. Amrita Hospital also gave a letter to the family for submission to the Employees State Insurance Corporation (ESIC)," said Dr Mahesh K, paediatric cardiologist at the hospital.
Most children who are infected with the COVID-19 virus develop only a mild illness; but in children who go on to develop MIS-C due to the infection, organs like the heart, lungs, blood vessels, kidneys and brain become severely inflamed. It is an immune system mediated hyper-inflammation targeting children and teenagers. More than 50% of patients develop heart problems.
Meanwhile, Adhik has come out of the intensive care unit, and is making steady progress. "We are all positive and hopeful. Adhik has so far responded well to treatment. He was taken off ECMO after 72 hours. We were also able to take him off the ventilator two days later. In a few weeks, he will be back to normal,” said Dr Suma.