A Case Report of a Young Infant with COVID Multisystem Inflammatory Syndrome in Children, Cardiogenic Shock, and Refractory Arrhythmias Revived with Peripheral Venoarterial Extracorporeal Membrane Oxygenation

We report the case of a 1 month 25-day-old boy with possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem hyperinflammatory syndrome presenting with refractory cardiac arrhythmias and cardiogenic shock, who was managed with extracorporeal life support and fully recovered.The baby presented with cardiac arrest and was resuscitated with cardiopulmonary resuscitation (CPR).Following the return of spontaneous circulation, he had recurrent supraventricular tachyarrhythmias.He was managed with ventilation, antiarrhythmic medications, defibrillation, and inotropes; however, he continued to have recurrent refractory supraventricular tachyarrhythmias with progressive worsening of ventricular contractility.Emergency peripheral venoarterial (VA) extracorporeal membrane oxygenation (VA-ECMO) was initiated for refractory arrhythmias with circulatory shock.At presentation, reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was negative; however, SARS-CoV-2 antibody testing was positive.Inflammatory markers and cardiac biomarkers were significantly elevated, suggesting diagnosis of multisystem inflammatory syndrome in children, for which he received steroids and intravenous immunoglobulin.During the clinical course, recovery of cardiac function was demonstrated.To the best of our knowledge, this is the youngest, previously healthy baby who had refractory arrhythmias and cardiogenic shock secondary to possible multisystem hyperinflammatory syndrome, successfully rescued with ECMO support.