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. 2012 Dec;55(12):1633-41.
doi: 10.1093/cid/cis783. Epub 2012 Sep 18.

Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation

Matthieu Schmidt  1 , Nicolas Bréchot, Sarah Hariri, Marguerite Guiguet, Charles Edouard Luyt, Ralouka Makri, Pascal Leprince, Jean-Louis Trouillet, Alain Pavie, Jean Chastre, Alain Combes
Affiliations

Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation

Matthieu Schmidt et al. Clin Infect Dis. 2012 Dec.

Abstract

Background: Incidence and impact on adult patients' outcomes of nosocomial infections (NIs) occurring during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock have rarely been described.

Methods: We retrospectively reviewed the charts of a large series of patients who received VA-ECMO in our intensive care unit (ICU) from January 2003 through December 2009. Incidence, types, risk factors, and impact on outcomes of NIs occurring during ECMO support were analyzed.

Results: Among 220 patients (49 ± 16 years old, simplified acute physiology score (SAPS) II 61 ± 20) who underwent ECMO support for >48 hours for a total of 2942 ECMO days, 142 (64%) developed NIs. Ventilator-associated pneumonia (VAP), bloodstream infections, cannula infections, and mediastinitis infections occurred in 55%, 18%, 10% and 11% of the patients, respectively. More critical condition at ICU admission, but not antibiotics at the time of ECMO cannulation, was associated with subsequently developing NIs (hazard ratio, 0.73; 95% confidence interval [CI], .50-1.05; P = .09). Infected patients had longer durations of mechanical ventilation, ECMO support, and hospital stays. Independent predictors of death were infection with severe sepsis or septic shock (odds ratio, 1.93; 95% CI, 1.26-2.94; P = .002) and SAPS II, whereas immunosuppression and myocarditis as the reason for ECMO support were associated with better outcomes.

Conclusions: Cardiogenic shock patients who received the latest generation VA-ECMO still had a high risk of developing NIs, particularly VAP. Strategies aimed at preventing these infections may improve the outcomes of these critically ill patients.

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Figures

Figure 1.
Figure 1.
Kaplan−Meier estimates of the unadjusted cumulative probability of being free of infection (bold line) for patients with venoarterial extracorporeal membrane oxygenation. Upper and lower bands represent 95% confidence interval of the cumulative probability. Abbreviation: ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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