Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb;46(2):182-191.
doi: 10.1007/s00134-019-05847-z. Epub 2019 Nov 25.

ECLS-associated infections in adults: what we know and what we don't yet know

Darryl Abrams  1   2 , Giacomo Grasselli  3   4 , Matthieu Schmidt  5   6 , Thomas Mueller  7 , Daniel Brodie  8   9
Affiliations
Review

ECLS-associated infections in adults: what we know and what we don't yet know

Darryl Abrams et al. Intensive Care Med. 2020 Feb.

Abstract

Extracorporeal life support (ECLS) is increasingly used in the management of patients with severe cardiopulmonary disease. Infections are frequently the etiologies underlying the respiratory, and occasionally cardiac, failure that necessitates ECLS. Just as importantly, infections are among the most commonly reported adverse events during ECLS. Infections in this setting may be the sequelae of prolonged critical illness or of underlying immune dysregulation; they may be hospital-acquired infections, and they may or may not be attributable to the presence of ECLS itself, the latter being an aspect that can be difficult to determine. Current registry data and evidence from the literature offer some insights, but also leave open many questions regarding the nature and significance of infections reported both before and during ECLS, including the question of any causal link between ECLS and the development of infections. An ongoing lack of consistency in the identification, diagnosis, management, and prevention of infections during ECLS is limiting our ability to interpret literature data and thus highlighting the need for more rigorous investigation and standardization of definitions. This review aims to characterize the current understanding of infections associated with the use of ECLS, taking into account data from the updated Extracorporeal Life Support Organization Registry, which provides important context for understanding the epidemiology and outcomes of these patients.

Keywords: Complications; ECLS; ECMO; ELSO registry; Infections; Nosocomial.

PubMed Disclaimer

Conflict of interest statement

MS has received lectures fees from Getinge, Xenios and Dräger, outside the submitted work. DB reports fees to his university from ALung Technologies, personal fees from Baxter and anticipated fees from BREETHE, an unpaid association with Hemovent, outside the submitted work. GG received payment for lectures from Draeger Medical, Getinge, Fisher and Paykel, Pfizer, and received travel/accommodations/congress registration support from Getinge and Biotest, outside the submitted work.

Figures

Fig. 1
Fig. 1
Most common organisms identified on culture prior to initiation of ECLS for respiratory and cardiac failure. Based on a total of 17,374 ECLS runs for respiratory failure and a total of 18,514 total ECLS runs for cardiac failure from January 2012 through July 2019. Event rate represents the number of positive cultures for a given organism divided by the total number of ECLS runs. ECLS extracorporeal life support
Fig. 2
Fig. 2
Most common organisms identified on culture during ECLS for respiratory and cardiac failure. Based on a total of 17,374 total ECLS runs for respiratory failure and a total of 18,514 total ECLS runs for cardiac failure from January 2012 through July 2019. Event rate represents the number of positive cultures for a given organism divided by the total number of ECLS runs. ECLS extracorporeal life support
Fig. 3
Fig. 3
Most common organisms identified on culture prior to initiation of ECLS (a) and during ECLS (b) for cardiac arrest. Based on a total of 5979 ECLS runs for cardiac arrest from January 2012 through July 2019. Event rate represents the number of positive cultures for a given organism divided by the total number of ECLS runs. ECLS extracorporeal life support
Fig. 4
Fig. 4
Potential strategies to reduce infections during ECLS. ECLS extracorporeal life support, VAP ventilator-associated pneumonia
Fig. 5
Fig. 5
Research agenda and ongoing uncertainties regarding ECLS-associated infections. ECLS extracorporeal life support
See this image and copyright information in PMC

References

    1. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63:2769–2778. doi: 10.1016/j.jacc.2014.03.046. - DOI - PubMed
    1. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA. 2019;322:557–568. doi: 10.1001/jama.2019.9302. - DOI - PubMed
    1. Abrams D, Garan AR, Abdelbary A, Bacchetta M, Bartlett RH, Beck J, Belohlavek J, Chen YS, Fan E, Ferguson ND, Fowles JA, Fraser J, Gong M, Hassan IF, Hodgson C, Hou X, Hryniewicz K, Ichiba S, Jakobleff WA, Lorusso R, MacLaren G, McGuinness S, Mueller T, Park PK, Peek G, Pellegrino V, Price S, Rosenzweig EB, Sakamoto T, Salazar L, Schmidt M, Slutsky AS, Spaulding C, Takayama H, Takeda K, Vuylsteke A, Combes A, Brodie D, International EN, The Extracorporeal Life Support O Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med. 2018;44:717–729. doi: 10.1007/s00134-018-5064-5. - DOI - PubMed
    1. Thiagarajan RR, Barbaro RP, Rycus PT, McMullan DM, Conrad SA, Fortenberry JD, Paden ML, ELSO member centers Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63:60–67. doi: 10.1097/MAT.0000000000000475. - DOI - PubMed
    1. Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, Vuylsteke A, Guervilly C, McGuinness S, Pierard S, Breeding J, Stewart C, Ching SSW, Camuso JM, Stephens RS, King B, Herr D, Schultz MJ, Neuville M, Zogheib E, Mira JP, Roze H, Pierrot M, Tobin A, Hodgson C, Chevret S, Brodie D, Combes A. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An international multicenter prospective cohort. Am J Respir Crit Care Med. 2019;200:1002–1012. doi: 10.1164/rccm.201806-1094OC. - DOI - PubMed

MeSH terms