A Retrospective Study of Infection in Patients Requiring Extracorporeal Membrane Oxygenation Support
| Autor: | Samuel M. Galvagno, Gregory P. Boyajian, Ali Tabatabai, Michael A. Mazzeffi, Raymond Rector, Megan T. Quintana, Ronson J. Madathil, David J. Kaczorowski, Daniel Herr, Nicole Hays, Danny Herrera, Joseph Rabin |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty medicine.medical_treatment Bacteremia 030204 cardiovascular system & hematology Extracorporeal law.invention Catheterization 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation Postoperative Complications law Extracorporeal membrane oxygenation Medicine Humans Extracorporeal cardiopulmonary resuscitation Cardiac Surgical Procedures Aged Retrospective Studies Cross Infection business.industry Incidence Retrospective cohort study Pneumonia Middle Aged medicine.disease Intensive care unit Intensive Care Units surgical procedures operative 030228 respiratory system Respiratory failure Life support Emergency medicine Surgery Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 112(4) |
| ISSN: | 1552-6259 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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