Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics

Allou, Nicolas; Pinto, Hugo Lo; Persichini, Romain; Bouchet, Bruno; Braunberger, Éric; Lugagne, Nathalie; Belmonte, Olivier; Martinet, Olivier; Delmas, Benjamin; Dangers, Laurence; Allyn, Jérôme

doi:10.1097/mat.0000000000000771

Cited by 47 publications

(48 citation statements)

References 18 publications

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“…Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a temporary mechanical circulatory support that has been increasingly used over the last decade to restore and maintain adequate end-organ perfusion and improve outcomes in patients with refractory cardiogenic shock [1,2]. Nevertheless, the weaning of VA-ECMO should be daily questioned, as several studies reported severe complications like cannula-related infections [3], bleeding [4], and thromboembolic events [5] associated with prolonged VA-ECMO durations. Dobutamine is currently used to improve myocardial contractility during VA-ECMO, aiming to enhance left ventricular ejection and aortic valve opening and also to shorten ECMO duration.…”

Section: Introductionmentioning

confidence: 99%

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

et al. 2020

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Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used over the last decade in patients with refractory cardiogenic shock. ECMO weaning can, however, be challenging and lead to circulatory failure and death. Recent data suggest a potential benefit of levosimendan for ECMO weaning. We sought to further investigate whether the use of levosimendan could decrease the rate of ECMO weaning failure in adult patients with refractory cardiogenic shock. Methods: We performed an observational single-center cohort study. All patients undergoing VA-ECMO from January 2012 to December 2018 were eligible and divided into two groups: group levosimendan and group control (without levosimendan). The primary endpoint was VA-ECMO weaning failure defined as death during VA-ECMO treatment or within 24 h after VA-ECMO removal. Secondary outcomes were mortality at day 28 and at 6 months. The two groups were compared after propensity score matching. P < 0.05 was considered statistically significant. Results: Two hundred patients were analyzed (levosimendan group: n = 53 and control group: n = 147). No significant difference was found between groups on baseline characteristics except for ECMO duration, which was longer in the levosimendan group (10.6 ± 4.8 vs. 6.5 ± 4.7 days, p < 0.001). Levosimendan administration started 6.6 ± 5.4 days on average following ECMO implantation. After matching of 48 levosimendan patients to 78 control patients, the duration of ECMO was similar in both groups. The rate of weaning failure was 29.1% and 35.4% in levosimendan and control groups, respectively (OR: 0.69, 95%CI: 0.25-1.88). No significant difference was found between groups for all secondary outcomes. Conclusion: Levosimendan did not improve the rate of successful VA-ECMO weaning in patients with refractory cardiogenic shock. Trial registration: ClinicalTrials.gov, NCT04323709.

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Section: Introductionmentioning

confidence: 99%

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

et al. 2020

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“…Previous studies have focused on one complication at a time (nosocomial infection, thromboembolic event, bleeding, transfusion, etc.) and on the relationship between this specific complication and death [ 1 – 3 , 8 , 9 , 23 , 24 ]. Our study used a large cohort and a methodology that allowed us to highlight: i ) complications that cluster together and cluster close to death; and ii ) four patterns of patients according to complications, including one with no complications.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequent complications are hemorrhagic, thrombotic, and infectious events [ 3 – 7 ]. While previous studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others [ 1 – 3 , 8 , 9 ]. For example, hemorrhagic shock and/or blood transfusion can favor the occurrence of a bacterial infection and/or of a thrombotic event [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification

et al. 2018

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BackgroundTreatment by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used today, even though it is associated with high risks of complications and death. While studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others. Our objective was to describe the relationship between complications in patients undergoing VA-ECMO in intensive care unit (ICU) and to identify, if possible, patterns of patients according to complications.Methods and findingsAs part of a retrospective cohort study, we conducted a multiple correspondence analysis followed by a hierarchical ascendant classification in order to identify patterns of patients according to main complications (sepsis, thromboembolic event, major transfusion, major bleeding, renal replacement therapy) and in-ICU death. Our cohort of 145 patients presented an in-ICU mortality rate of 50.3%. Morbidity was high, with 36.5% of patients presenting three or more of the five complications studied. Multiple correspondence analysis revealed a cumulative inertia of 76.9% for the first three dimensions. Complications were clustered together and clustered close to death, prompting the identification of four patterns of patients according to complications, including one with no complications.ConclusionsOur study, based on a large cohort of patients undergoing VA-ECMO in ICU and presenting a mortality rate comparable to that reported in the literature, identified numerous and often interrelated complications. Multiple correspondence analysis and hierarchical ascendant classification yielded clusters of patients and highlighted specific links between some of the complications studied. Further research should be conducted in this area.

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“…Higher yet, are the rates of nosocomial infections, with published incidence rates ranging from 8-64%. These account for blood stream or peripherally-inserted cannula infections, and ventilator associated pneumonia (VAP) (16)(17)(18)30). It is understandable that critically-ill patients with multiple invasive lines, ongoing mechanical ventilation, VA-ECMO circuit exposure to blood, and higher length of ICU stay, are at higher risk for developing an infection.…”

Section: Infection and Significant Inflammationmentioning

confidence: 99%

“…Studies have shown that the most common bloodstream pathogens identified in VA-ECMO-supported patients are Staphylococcus aureus and other staphylococcus organisms, accounting for up to 38% of all bacteremia cases (16)(17)(18). Just as in non-ECMO patients, VAP is a risk for patients supported on mechanical ventilation.…”

Section: Infection and Significant Inflammationmentioning

confidence: 99%

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

Koerner¹,

Harper²,

Gordon³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to be a viable and effective treatment for patients suffering from refractory cardiogenic shock (rCS), which is associated with high mortality rates. Although ECMO therapy used as short-term mechanical circulatory support (MCS) has shown tremendous growth in its application over the past decade, the complication and mortality rates remain high. This retrospective study analyzes complications associated with VA-ECMO support, evaluates the use of defined protocols at a single center, and examines factors that may contribute to patient complication and mortality. Methods: This retrospective analysis included 184 patients who were supported with ECMO from September 2014 through March 2018 at Integris Baptist Medical Center (IBMC). Descriptive statistics were generated to analyze baseline characteristics, demographics, complications, and outcomes. Results: Acute myocardial infarct (AMI) was the primary etiology of this cohort (N=40; 22%). The mean age was 55±15 (median 56, range 15-84) years. All patients were inotrope and/or vasopressor dependent prior to ECMO initiation. Mean time on ECMO support was 7.8±7.9 days with median time of 6 days. Total patient days on support were 1,430. Most ECMO cannulations, 97 (52%) were performed within Integris Baptist Medical Center, with 48% done outside the hospital; 38% were performed outside of the hospital by the IBMC ECMO team, and 10.5% were performed by an outside team. Bleeding was noted to be the most common VA ECMO complication [N=41; 22.3%; 0.028 events per patient day (EPPD)]. Conclusions: A dedicated 24/7 ECMO service using a multidisciplinary team (MDT) and defined protocols in a single center is able to effectively reduce complications due to VA-ECMO support in the sickest of the sick VA-ECMO patients.

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Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics

Cited by 47 publications

References 18 publications

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification

Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and management of acute complications

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