Nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation
1. In pediatric patients between the age of 0 to 16, those on VA-ECMO have a high proportion and early occurrence of infections, potentially prolonging duration of VA-ECMO support and PICU LOS.
Evidence Rating Level: 2 (Good)
Veno-arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) is a standard therapy in refractory cardiovascular failure. The use of VA-ECMO puts patients at risk for many complications, including nosocomial infections which occur at a frequency between 16 to 42%. Limited studies reviewing nosocomial infections related to ECMO in pediatric patients have been conducted in the past. This retrospective study aimed to determine the frequency, timing and factors associated with nosocomial infections in children on VA-ECMO support. This study included 41 patients between the ages of 0 to 16 years on VA-ECMO support for more than 6 hours, for those who required multiple uses of VA-ECMO, the first use was considered. The first PICU infection was defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without a positive sample. 24%of the patients developed an infection, with a median time to first infection being 4 days and Pseudomonas spp. being the most commonly detected organism. Longer PICU stay (greater than 14 days) and longer VA-ECMO support (>5 days) was associated with infection (OR 12 (95% CI 2.2–65.5; p = 0.004 and OR 5.9 (CI 95% 1.4–24.6; p = 0.01 respectively). Limitations to this study include the inability to rule out any infections that may have been present prior to ECMO initiation. Additionally, the study involved a small number of patients at a specific local practice, making results difficult to generalize. Finally, it is not known of other patients on the unit developed nosocomial infections. Overall, this study indicates that pediatric patients treated with VA-ECMO are at high risk of early nosocomial infection, and these infections were associated with longer VA-ECMO support and PICU stay. Future studies are needed to continue to understand the nature of nosocomial infections in pediatric populations on VA-ECMO supports, as well as ways to prevent and manage these infections.
Click to read the study in BMC Pediatrics
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