Infectious Complications of Postcardiotomy Extracorporeal Membrane Oxygenation

Incidence, risk factors and outcomes of nosocomial infection in adult patients supported by extracorporeal membrane oxygenation: a systematic review and meta-analysis

BACKGROUND

An increasing number of patients requires extracorporeal membrane oxygenation (ECMO) for life support. This supportive modality is associated with nosocomial infections (NIs). This systematic review and meta-analysis aim to assess the incidence and risk factors of NIs in adult.

METHODS

We searched PubMed, Scopus, Web of Science, and ProQuest databases up to 2022. The primary endpoint was incidence of NI. Secondary endpoints included time to infection, source of infection, ECMO duration, Intensive care and hospital length of stay (LOS), ECMO survival and overall survival. Incidence of NI was reported as pooled proportions and 95% confidence intervals (CIs), while dichotomous outcomes were presented as risk ratios (RR) as the effective index and 95% CIs using a random-effects model.

RESULTS

Among the 4,733 adult patients who received ECMO support in the 30 included studies, 1,249 ECMO-related NIs per 1000 ECMO-days was observed. The pooled incidence of NIs across 18 studies involving 3424 patients was 26% (95% CI 14-38%).Ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) were the most common NI sources. Infected patients had lower ECMO survival and overall survival rates compared to non-infected patients, with risk ratio values of 0.84 (95% CI 0.74-0.96, P = 0.01) and 0.80 (95% CI 0.71-0.90, P < 0.001), respectively.

CONCLUSION

Results showed that 16% and 20% lower of ECMO survival and overall survival in patients with NI than patients without NI, respectively. However, NI increased the risk of in-hospital mortality by 37% in infected patients compared with non-infected patients. In addition, this study identified the significant positive correlation between ECMO duration and ECMO-related NI.

Outcome and Clinical Characteristics of Nosocomial Infection in Adult Patients Undergoing Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Objective

This study conducts a meta-analysis of clinical outcomes of nosocomial infection in adult patients receiving extracorporeal membrane oxygenation (ECMO) and systematically evaluates clinical epidemiological characteristics.

Methods

Document retrieval strategies were determined, and all adult patients treated by ECMO were included. The prevalence, incidence, mortality, ECMO use time, intensive care unit (ICU) stay time, hospital stay time, and risk factors of nosocomial infection were systematically evaluated. Subsequently, a meta-analysis of the impact of nosocomial infection on risk of in-hospital mortality was conducted.

Results

A total of 25 retrospective studies were included, and 19 studies were included in the meta-analysis. The prevalence of nosocomial infection was 8.8–64.0%, incidence was 1.7–85.4‰ (per 1,000 ECMO days), and in-hospital mortality was 31.5–75.4%. The duration of ECMO usage and length of ICU stay were longer for infected patients. Compared with non-infected patients, the meta-analysis revealed that nosocomial infection increased the relative risk of death of adult patients receiving ECMO by 32%. The risk factors included the duration of ECMO usage and disease severity score.

Conclusions

Adult patients treated by ECMO have high prevalence of nosocomial infection. In addition, their ECMO use time and ICU stays are longer. Nosocomial infection significantly increases the relative risk of in-hospital mortality.