Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults*

Objective: To determine current rates, risk factors, and causal organisms related to infections acquired during extracorporeal membrane oxygenation (ECMO). Design: A descriptive and retrospective case-control study. Setting: ECMO centers belonging to the Extracorporeal Life Support Organization. Patients: The Extracorporeal Life Support Organization Registry was queried for data related to all ECMO cases from 1998 through 2008. All culture-proven infections obtained from any site during ECMO support and not believed preexisting were included. Infection rates were analyzed by age category (i.e., neonatal, pediatric, adult), indication for ECMO (i.e., respiratory, cardiac, cardiopulmonary resuscitation), mode of ECMO (e.g., venovenous), and duration of ECMO support. Infected and noninfected ECMO patients were compared. Interventions: None. Measurements and Main Results: A total of 2,418 infections were reported during 20,741 (11.7%) ECMO cases for a rate of 15.4 per 1,000 ECMO days. Rates were highest in the adult vs. the pediatric and neonatal populations (30.6 vs. 20.8 vs. 10.1 infections per 1,000 ECMO days, respectively) and in those necessitating extracorporeal cardiopulmonary resuscitation (24.7 infections per 1,000 ECMO days). In each age category, venoarterial ECMO was the mode of support associated with the highest rate of infection. Prevalence of infection increased with duration of ECMO support from 6.1% of those requiring bypass for ≤7 days to 30.3% of those requiring ECMO for >14 days (p < .001). Coagulase-negative staphylococci (15.9%) were the most common organisms cultured followed by species of Candida (12.7%), and Pseudomonas (10.5%). Those with an infection acquired during ECMO support were significantly older, had a longer duration of ECMO, a longer duration of post-ECMO ventilatory support, and a higher prevalence of death than those without. Conclusions: Infections acquired during ECMO are common and can have significant associated consequences. Knowledge of high-risk patients and common causal organisms may improve strategies for treatment and prevention, but further work to develop strategies and guidelines for prevention of these infections is urgently needed.