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
. 2023 Feb 23;23(1):89.
doi: 10.1186/s12887-023-03908-3.

First nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO)

Vladimir L Cousin #  1 , Robert Rodriguez-Vigouroux #  2 , Oliver Karam  3 , Peter Rimensberger  4 , Klara M Posfay-Barbe  5
Affiliations

First nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO)

Vladimir L Cousin et al. BMC Pediatr. .

Abstract

Background: Veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a standard procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). There is a paucity of data on the time relationship between VA-ECMO support, nosocomial infection occurrence, and PICU length of stay (LOS). The aim of this study was to determine the characteristics and impact of ECMO-related infections.

Methods: This is a retrospective study from 01/2008 to 12/2014, enrolling children with a VA-ECMO support for > 6 h. We recorded the first PICU infection during the VA-ECMO run, defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample.

Results: During the study period, 41 patients (25/41 male) were included, with a median age of 41.2 months (IQR 12.9-89.9) and a 53% mortality rate. Median time on VA-ECMO was 4.2 d (IQR 2-7.1), median PICU LOS was 14.7 d (IQR 4,7-26,9). Overall, 34% patients developed an infection, with an incidence of 60/1000 VA-ECMO days. Median time to first infection was 4 d (IQR 3-5), with Pseudomonas spp. being the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4-24.6; p = 0.01) and longer PICU stay (> 14 d) (OR 12 (95% CI 2.2-65.5; p = 0.004) were associated with infection.

Conclusion: In this single-center study, we underlined the high proportion and early occurrence of infections in patient on VA-ECMO, mostly in the first week. As infection was an early event, it may prolong the duration of VA-ECMO support and PICU LOS. Further research is needed to better understand the impact of infections on VA-ECMO and develop prevention strategies.

Keywords: ECMO; Infection; Nosocomial; PICU.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. VA- ECMO: venous-arterial extracorporeal membrane oxygenation
Fig. 2
Fig. 2
Cumulative probability of survival during PICU stay for patient with VA-ECMO. Kaplan–Meier estimated of the unadjusted cumulative probability of survival during PICU stay. Vertical lines represent censored patients (leave PICU alive). PICU: pediatric intensive care unit
Fig. 3
Fig. 3
Cumulative probability of first infection during VA-ECMO support. Kaplan–Meier estimates of the unadjusted cumulative probability of being infection free for patients with infection (N = 14) treated with VA-ECMO
Fig. 4
Fig. 4
Cumulative probability of survival during PICU stay for patient with VA-ECMO, depending on infection status. Kaplan–Meier cumulative probability of survival during PICU stay for patient with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), adjusted on infection status. Comparison of curve using log-rank test found significant difference with a p value p = 0.2. In blue patient without an infection (N = 27). In red patient with an infection (N = 14). PICU: pediatric intensive care unit
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs. 1976;22:80–93. - PubMed
    1. Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, et al. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021;67(5):463–475. doi: 10.1097/MAT.0000000000001431. - DOI - PubMed
    1. MacLaren G, Schlapbach LJ, Aiken AM. Nosocomial Infections During Extracorporeal Membrane Oxygenation in Neonatal, Pediatric, and Adult Patients: A Comprehensive Narrative Review. Pediatr Crit Care Med. 2020;21(3):283–290. doi: 10.1097/PCC.0000000000002190. - DOI - PubMed
    1. Cashen K, Reeder R, Dalton HJ, Berg RA, Shanley TP, Newth CJL, Pollack MM, Wessel D, Carcillo J, Harrison R, et al. Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation. Perfusion. 2018;33(6):472–482. doi: 10.1177/0267659118766436. - DOI - PMC - PubMed
    1. Castagnola E, Gargiullo L, Loy A, Tatarelli P, Caviglia I, Bandettini R, Grasso C, Lampugnani E, Pezzato S, Tuo P, et al. Epidemiology of Infectious Complications During Extracorporeal Membrane Oxygenation in Children: A Single-Center Experience in 46 Runs. Pediatr Infect Dis J. 2018;37(7):624–626. doi: 10.1097/INF.0000000000001873. - DOI - PubMed

Publication types