A Retrospective Study of Infection in Patients Requiring Extracorporeal Membrane Oxygenation Support

Authors

Megan T. Quintana, The George Washington University School of Medicine and Health Sciences
Michael Mazzeffi, University of Maryland School of Medicine
Samuel M. Galvagno, University of Maryland School of Medicine
Danny Herrera, University of Maryland School of Medicine
Gregory P. Boyajian, University of Maryland School of Medicine
Nicole M. Hays, University of Maryland School of Medicine
David Kaczorowski, University of Maryland School of Medicine
Ronson J. Madathil, University of Maryland School of Medicine
Raymond P. Rector, University of Maryland Medical Center
Ali Tabatabai, University of Maryland School of Medicine
Daniel Herr, University of Maryland School of Medicine
Joseph Rabin, University of Maryland School of Medicine

Document Type

Conference Proceeding

Publication Date

1-1-2021

Journal

Annals of Thoracic Surgery

DOI

10.1016/j.athoracsur.2020.12.012

Abstract

Background: Healthcare-associated infections (HAIs) in critically ill patients are a serious public health problem. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for patients with severe cardiac or respiratory failure, but it may increase HAI risk. The goal of our study was to characterize HAIs in ECMO patients at an ECMO referral center. Methods: This institutional review board–approved study identified all consecutive adult ECMO patients admitted to the cardiac surgery intensive care unit (CSICU) between January 1, 2015, and December 31, 2017. Demographic data, diagnosis, ECMO cannulation technique, and survival were collected. Urinary tract infection, pneumonia, and bacteremia incidence during ECMO and within 3 months of decannulation were collected. Outcomes of patients with HAIs were compared with noninfected patients, the CSICU infection incidence, and overall Extracorporeal Life Support Organization survival data. Results: There were 288 ECMO patients and 3396 CSICU admissions during this period. Survival was 72.3% for venoarterial ECMO, 85.3% for venovenous ECMO, and 57.1% for multimodality or veno-arteriovenous ECMO, with discharge survival of 60.2%, 72.0%, and 28.6%, respectively. Bacteremia incidence while cannulated was 6.8% for venoarterial ECMO and 9.3% for venovenous ECMO. Bacteremia occurred in 22 of 288 (7.6%) ECMO patients, compared with 48 of 3109 (1.5%) in non-ECMO CSICU patients, which was statistically significant (P < .002). Bacteremia and pneumonia were associated with decreased VA-ECMO survival, with prolonged overall requirements for ECMO support. Conclusions: Nosocomial ECMO infections are significantly higher than in other CSICU patients. Infection risk remains significant even after decannulation. Infection is associated with increased mortality and longer duration of ECMO support. Further efforts are needed to determine HAI reduction strategies in this high-risk patient population.

APA Citation

Quintana, M., Mazzeffi, M., Galvagno, S., Herrera, D., Boyajian, G., Hays, N., Kaczorowski, D., Madathil, R., Rector, R., Tabatabai, A., Herr, D., & Rabin, J. (2021). A Retrospective Study of Infection in Patients Requiring Extracorporeal Membrane Oxygenation Support. Annals of Thoracic Surgery, (). http://dx.doi.org/10.1016/j.athoracsur.2020.12.012