1
|
Takashima M, Hyun A, Xu G, Lions A, Gibson V, Cruickshank M, Ullman A. Infection Associated With Invasive Devices in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e42-e56. [PMID: 38161188 DOI: 10.1542/hpeds.2023-007194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT Indwelling invasive devices inserted into the body for extended are associated with infections. OBJECTIVE This study aimed to estimate infection proportion and rates associated with invasive devices in pediatric healthcare. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) postinsertion infection complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device local, organ, and bloodstream infection (BSIs) pooled proportion and incidence rate (IR) per-1000-device-days per device type were reported. RESULTS A total of 116 studies (61 554 devices and 3 632 364 device-days) were included. The highest number of studies were central venous access devices associated BSI (CVAD-BSI), which had a pooled proportion of 8% (95% confidence interval [CI], 6-11; 50 studies) and IR of 0.96 per-1000-device-days (95% CI, 0.78-1.14). This was followed by ventilator-associated pneumonia in respiratory devices, which was 19% (95% CI, 14-24) and IR of 14.08 per-1000-device-days (95%CI, 10.57-17.58). CONCLUSIONS Although CVAD-BSI and ventilator associated pneumonia are well-documented, there is a scarcity of reporting on tissue and local organ infections. Standard guidelines and compliance initiatives similar to those dedicated to CVADs should be implemented in other devices in the future.
Collapse
Affiliation(s)
- Mari Takashima
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Areum Hyun
- The University of Queensland, Queensland, Australia
| | - Grace Xu
- The University of Queensland, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | | | - Victoria Gibson
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Marilyn Cruickshank
- Sydney Children's Hospitals Network, New South Wales, Australia
- The University of Technology Sydney, New South Wales, Australia
| | - Amanda Ullman
- The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| |
Collapse
|
2
|
Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
Collapse
Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| |
Collapse
|
3
|
Savaş H, Guler S. Prevention of catheter-related bloodstream infections in patients with extracorporeal membrane oxygenation: a literature review. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230491. [PMID: 37729228 PMCID: PMC10511280 DOI: 10.1590/1806-9282.20230491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/22/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Hafize Savaş
- Lokman Hekim University, Faculty of Health Sciences, Nursing Department – Ankara, Turkey
| | - Sevil Guler
- Gazi University, Faculty of Nursing – Ankara, Turkey
| |
Collapse
|
4
|
Lucchini A, Elli S, Piovera D, Grossulè M, Giannini L, Cannizzo L, Crosignani A, Rona R, Foti G, Giani M. Management of vascular access for extracorporeal life support: A cohort study. J Vasc Access 2023; 24:1167-1173. [PMID: 34763544 DOI: 10.1177/11297298211056755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is required for patients with refractory cardiac or respiratory failure. Inadequate securement of ECMO cannulae may lead to adverse events, ranging from line kinking to catastrophic accidents, such as air entrainment into the circuit or massive bleeding. Furthermore, the micro-motion of the cannulae at the entry site might increase the risk of local infections. Since 2015, we implemented a written protocol for management of ECMO cannulae and tubing, which specifically includes the securement of each cannula with three sutureless devices. The aim of the present study was to retrospectively assess cannulae micro-motion and the rate of bleeding events at the insertion site. Secondarily we aimed to evaluate the impact of prone positioning maneuvers during ECMO on these events. We performed a single-centre retrospective analysis of prospectively collected data on nursing care of ECMO cannulae. We included adult patients treated with veno-venous (V-V) or veno-arterial (V-A) ECMO between 2015 and 2018 in our general intensive care unit. The distance between the insertion site and the end of the wire-wound part of the cannula was recorded daily. Variations of this distance (defined as "cannula micro-motion") were recorded. Forty-five ECMO consecutive adult patients (40 V-V and 5 V-A) were included. No accidental cannula dislodgement was recorded. Median daily "cannula micro-motion" was 0.0 (-0.5 to 0.2) cm, without any significant difference between ECMO configuration, cannula type, and insertion site. Twelve patients (26%) presented at least one bleeding episode at cannula insertion site, none of which required surgical intervention. In the subgroup of patients who underwent prone positioning, no difference in cannulae micro-motion was recorded. An ECMO nursing protocol for cannulae management providing sutureless devices for cannula and tubing securement allows safe line stabilization, with the potential to reduce complications related to ECMO vascular access.
Collapse
Affiliation(s)
- Alberto Lucchini
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Stefano Elli
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Daniele Piovera
- General Intensive Care and ECMO Unit, IRCCS San Matteo, Pavia, Italy
| | | | - Luciano Giannini
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Luigi Cannizzo
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Andrea Crosignani
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Roberto Rona
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Guseppe Foti
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| | - Marco Giani
- General Intensive Care Unit, Emergency Department, ASST Monza San Gerardo Hospital, Monza, Italy
- University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
5
|
A Revolutionary, Proven Solution to Vascular Access Concerns: A Review of the Advantageous Properties and Benefits of Catheter Securement Cyanoacrylate Adhesives. JOURNAL OF INFUSION NURSING 2022; 45:154-164. [PMID: 35537003 DOI: 10.1097/nan.0000000000000467] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravascular catheters are widely used among hospitals; however, their failure rates are high, up to 50%, when secured by traditional techniques, such as tape and gauze. The use of catheter securement cyanoacrylate adhesives provides a unique approach to the issues surrounding the use of traditional securement techniques for vascular access devices by providing significant securement strength, barrier properties, antibacterial properties, hemostatic properties, and flexibility. The purpose of this research was to perform a thorough and systematic review of the current literature existing regarding the use of cyanoacrylate adhesive for the care and maintenance of vascular access devices.
Collapse
|
6
|
Pittiruti M, Annetta MG, Marche B, D'Andrea V, Scoppettuolo G. Ten years of clinical experience with cyanoacrylate glue for venous access in a 1300-bed university hospital. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S4-S13. [PMID: 35439068 DOI: 10.12968/bjon.2022.31.8.s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the past decade, cyanoacrylate glue has been progressively introduced into the clinical practice of venous access devices used for different purposes. Glue has been used to increase device stabilisation (to reduce the risk of catheter dislodgement), to seal the exit site (to both reduce local bleeding and decrease the risk of bacterial contamination) and to close skin incisions required for the insertion of tunnelled catheters or totally implanted venous ports. For many of these purposes, the efficacy and cost-effectiveness of cyanoacrylate glue has been demonstrated, while some indications are still controversial. This article reports on 10 years of clinical experience with cyanoacrylate glue in a large university hospital, and provides a narrative review of the scientific evidence on the benefits of glue in venous access that has been accumulating over the past decade.
Collapse
Affiliation(s)
- Mauro Pittiruti
- Vascular Access Specialist and Vascular Access Team Member, Department of Surgery, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Maria Giuseppina Annetta
- Vascular Access Specialist and Vascular Access Team Member, Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Bruno Marche
- Vascular Access Specialist and Vascular Access Team Member, Department of Hematology, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Vito D'Andrea
- Neonatologist, Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| | - Giancarlo Scoppettuolo
- Infectious Disease Specialist, and Consultant for the Vascular Access Team, Department of Infectious Disease, Fondazione Policlinico Universitario A Gemelli, Catholic University, Rome Italy
| |
Collapse
|
7
|
Li ZJ, Zhang DF, Zhang WH. Analysis of Nosocomial Infection and Risk Factors in Patients with ECMO Treatment. Infect Drug Resist 2021; 14:2403-2410. [PMID: 34211285 PMCID: PMC8241808 DOI: 10.2147/idr.s306209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the drug resistance of nosocomial infection-related pathogens in patients who underwent extracorporeal membrane oxygenation (ECMO), analyzing the nosocomial infection-related risk factors. Methods The medical records of 56 patients who received ECMO support treatment in the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2019 were selected. The nosocomial infection, pathogen distribution and drug resistance, and the influencing factors of nosocomial infection were analyzed. The predictive value of independent risk factors for nosocomial infection after ECMO was analyzed using the receiver operating characteristic (ROC) curve. Results A total of 56 patients receiving ECMO treatment were included. The nosocomial infection rate was 28.57%, and the prevalence infection rate was 44.64%. Lower respiratory tract infection was the main infection site. Among these infectious patients, 53 strains of pathogens were detected. The results showed that the gram-negative bacteria were mainly Acinetobacter baumannii and Klebsiella pneumonia. Moreover, the drug resistance rate of Acinetobacter baumannii to most of the antibiotics was more than 65%, among which the drug resistance rate to carbapenems was 80%. The results of risk factors of nosocomial infection after ECMO were analyzed by univariate analysis, showing that ECMO treatment time, hospitalization time, antibacterial drug use time, ventilator use time, catheter intubation time and central venous intubation time were statistically significant (all p < 0.001). Multivariate analysis identified that ECMO treatment time was an independent risk factor. As showed by ROC curve, ECMO treatment time had a high predictive value for postoperative nosocomial infection. ECMO treatment times of more than 4.5 days were associated with an increased risk of nosocomial infection. Conclusion The nosocomial infection rate after ECMO was relatively high, and the main pathogens are Gram-negative bacteria. The selection of antibiotics should be based on the results of pathogen drug sensitivity.
Collapse
Affiliation(s)
- Zhan-Jie Li
- Department of Infection Control, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Dong-Fang Zhang
- Department of Infection Control, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434, People's Republic of China
| | - Wei-Hong Zhang
- Office of the Dean, Jiangsu Shengze Hospital Affiliated to Nanjing Medical University, Suzhou, Jiangsu, 215228, People's Republic of China
| |
Collapse
|
8
|
Pearse I, Corley A, Qu Y, Fraser J. Tissue adhesives for bacterial inhibition in extracorporeal membrane oxygenation cannulae. Intensive Care Med Exp 2021; 9:25. [PMID: 33969444 PMCID: PMC8107059 DOI: 10.1186/s40635-021-00388-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND One of the most serious complications of extracorporeal membrane oxygenation (ECMO) therapy is ECMO cannulae infection, which can occur at quadruple the rate of central venous catheter infections, and significantly impact morbidity and paediatric mortality. The objective of this in vitro observational study was to assess antimicrobial properties of two n-butyl-2-octyl cyanoacrylate tissue adhesive (TA) formulations for bacterial inhibition at peripheral ECMO cannulae insertion sites. METHODS Antimicrobial properties were assessed using modified agar disk-diffusion (n = 3) and simulated agar cannulation insertion site (n = 20) models. Both assays used Staphylococcus epidermidis which was seeded at the edge of the TA or dressing. Microorganism inhibition was visually inspected and evidenced by the presence or absence of a TA bacterial inhibition zone at 24 and 72 h. RESULTS Both TAs provided effective barriers to bacterial migration under cannula dressings, to cannula insertion sites and down cannula tunnels. Additionally, both TAs demonstrated distinct zones of inhibition produced when left to polymerise onto agar plates seeded with S. epidermidis. CONCLUSIONS N-Butyl-2-octyl cyanoacrylate TA appears to inhibit bacterial growth and migration of S. epidermidis. Application of TA to cannulae insertion sites may therefore be a potential bedside strategy for infection prevention in ECMO cannulae, but requires further testing before being used clinically for this purpose.
Collapse
Affiliation(s)
- India Pearse
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, QLD, Australia. .,Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia.
| | - Amanda Corley
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Yue Qu
- Biomedicine Discovery Institute, Department of Microbiology, School of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.,Department of Infectious Diseases, The Alfred Hospital and Central Clinical School,, Monash University, Melbourne, VIC, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, QLD, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Chermside, QLD, Australia
| |
Collapse
|
9
|
Pearse I, Corley A, Bartnikowski N, Fraser JF. In vitro testing of cyanoacrylate tissue adhesives and sutures for extracorporeal membrane oxygenation cannula securement. Intensive Care Med Exp 2021; 9:5. [PMID: 33502631 PMCID: PMC7840820 DOI: 10.1186/s40635-020-00365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO), an invasive mechanical therapy, provides cardio-respiratory support to critically ill patients when maximal conventional support has failed. ECMO is delivered via large-bore cannulae which must be effectively secured to avoid complications including cannula migration, dislodgement and accidental decannulation. Growing evidence suggests tissue adhesive (TA) may be a practical and safe method to secure vascular access devices, but little evidence exists pertaining to securement of ECMO cannulae. The aim of this study was to determine the safety and efficacy of two TA formulations (2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate) for use in peripherally inserted ECMO cannula securement, and compare TA securement to 'standard' securement methods. METHODS This in vitro project assessed: (1) the tensile strength and flexibility of TA formulations compared to 'standard' ECMO cannula securement using a porcine skin model, and (2) the chemical resistance of the polyurethane ECMO cannulae to TA. An Instron 5567 Universal Testing System was used for strength testing in both experiments. RESULTS Securement with sutures and n-butyl-2-octyl cyanoacrylate both significantly increased the force required to dislodge the cannula compared to a transparent polyurethane dressing (p = 0.006 and p = 0.003, respectively) and 2-octyl cyanoacrylate (p = 0.023 and p = 0.013, respectively). Suture securement provided increased flexibility compared to TA securement (p < 0.0001), and there was no statistically significant difference in flexibility between 2-octyl cyanoacrylate and n-butyl-2-octyl cyanoacrylate (p = 0.774). The resistance strength of cannula polyurethane was not weakened after exposure to either TA formulation after 60 min compared to control. CONCLUSIONS Tissue adhesive appears to be a promising adjunct method of ECMO cannula insertion site securement. Tissue adhesive securement with n-butyl-2-octyl cyanoacrylate may provide comparable securement strength to a single polypropylene drain stitch, and, when used as an adjunct securement method, may minimise the risks associated with suture securement. However, further clinical research is still needed in this area.
Collapse
Affiliation(s)
- India Pearse
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Nicole Bartnikowski
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.,School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
| |
Collapse
|
10
|
Nosocomial Infections During Extracorporeal Membrane Oxygenation in Neonatal, Pediatric, and Adult Patients: A Comprehensive Narrative Review. Pediatr Crit Care Med 2020; 21:283-290. [PMID: 31688809 DOI: 10.1097/pcc.0000000000002190] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation is increasingly used in critically ill patients with refractory cardiopulmonary failure. Nosocomial infection acquired during extracorporeal membrane oxygenation represents one of the most frequent complications but the available evidence on the risk of infection and its association with outcomes has not been comprehensively analyzed. We performed a narrative review examining the epidemiology of nosocomial infection during extracorporeal membrane oxygenation, association with clinical outcomes, and preventive strategies. DATA SOURCES We searched PubMed, Web of Science, EMBASE, and the Cochrane Library between 1972 and June 2018. STUDY SELECTION We included any article which detailed nosocomial infection during extracorporeal membrane oxygenation. Articles were excluded if they were not written in English, detailed extracorporeal membrane oxygenation use for infections acquired prior to extracorporeal membrane oxygenation, or used other forms of extracorporeal support such as ventricular assist devices. DATA EXTRACTION Two reviewers independently assessed eligibility and extracted data. We screened 984 abstracts and included 59 articles in the final review. DATA SYNTHESIS The reported risk of nosocomial infection among patients receiving extracorporeal membrane oxygenation ranged from 3.5% to 64% per extracorporeal membrane oxygenation run, while the incidence of infection ranged from 10.1 to 116.2/1,000 extracorporeal membrane oxygenation days. Nosocomial infections during extracorporeal membrane oxygenation were consistently associated with longer duration of extracorporeal membrane oxygenation and, in several large multicenter studies, with increased mortality. Risk factors for nosocomial infection included duration of extracorporeal membrane oxygenation, mechanical and hemorrhagic complications on extracorporeal membrane oxygenation, and use of venoarterial and central extracorporeal membrane oxygenation. Biomarkers had low specificity for infection in this population. Few studies examined strategies on how to prevent nosocomial infection on extracorporeal membrane oxygenation. CONCLUSIONS Nosocomial infections in extracorporeal membrane oxygenation patients are common and associated with worse outcomes. There is substantial variation in the rates of reported infection, and thus, it is possible that some may be preventable. The evidence for current diagnostic, preventive, and therapeutic strategies for infection during extracorporeal membrane oxygenation is limited and requires further investigation.
Collapse
|
11
|
Reisenauer JS, Neal JR, Joyce DL. Dermabond as a Novel Solution for Needle-Hole Repair in Arterial Cannula while on Extracorporeal Membrane Oxygenation Therapy. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2019; 51:160-162. [PMID: 31548738 PMCID: PMC6749162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
The annual incidence of extracorporeal membrane oxygenation (ECMO) for adult patients is increasing. Indications may vary from acute lung injury, ECMO-assisted cardiopulmonary resuscitation, to cardiac failure with an inability to wean from cardiopulmonary bypass. Complications may happen to the ECMO circuit, including cannula leaks from holes, cracks, or other damage, during the support period. Here, we present a novel solution for repairing a bleeding structural leak in the side of an arterial cannula. Dermabond was used to seal a small leak in the cannula likely caused by an earlier accidental needle puncture. Dermabond was applied to the area of damage, then allowed to cure, and wrapped with Ioban for increased stability. The patient was weaned from ECMO 2 days later without any complications from the repair of the cannula. The cannula was unable to be exchanged because of the small thoracotomy used to gain access for cannulation, so a repair was attempted. Moving the cannula to the femoral vessel was ruled out because of continued hypoxia and fear of creating a mixing cloud. Although less invasive incisions are becoming more common in cardiac surgery, these incisions for ECMO may be problematic if issues related to cannulas arise.
Collapse
Affiliation(s)
| | - James R. Neal
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - David L. Joyce
- Department of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota; and
| |
Collapse
|
12
|
Shekar K, Abrams D, Schmidt M. Awake extracorporeal membrane oxygenation in immunosuppressed patients with severe respiratory failure-a stretch too far? J Thorac Dis 2019; 11:2656-2659. [PMID: 31463086 DOI: 10.21037/jtd.2019.05.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland and Bond University, Queensland, Australia
| | - Darryl Abrams
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, NY, USA.,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Matthieu Schmidt
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris, France
| |
Collapse
|
13
|
Douglass ME, Goudie MJ, Pant J, Singha P, Hopkins S, Devine R, Schmiedt CW, Handa H. Catalyzed Nitric Oxide Release Via Cu Nanoparticles Leads to an Increase in Antimicrobial Effects and Hemocompatibility for Short Term Extracorporeal Circulation. ACS APPLIED BIO MATERIALS 2019; 2:2539-2548. [PMID: 33718805 DOI: 10.1021/acsabm.9b00237] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Devices used for extracorporeal circulation are met with two major medical concerns: thrombosis and infection. A device that allows for anticoagulant-free circulation while reducing risk of infection has yet to be developed. We report the use of a copper nanoparticle (Cu NP) catalyst for the release of nitric oxide (NO) from the endogenous donor S-nitrosoglutathione (GSNO) in a coating applied to commercial Tygon S3™ E-3603 poly(vinyl chloride) tubing in order to reduce adhered bacterial viability and the occurrence thrombosis for the first time in an animal model. Cu GSNO coated material demonstrated a nitric oxide (NO) release flux ranging from an initial flux of 6.3 ± 0.9 ×10-10 mol cm-2 min-1 to 7.1 ± 0.4 ×10-10 mol cm-2 min-1 after 4 h of release, while GSNO loops without Cu NPs only ranged from an initial flux of 1.1 ± 0.2 ×10-10 mol cm-2 min-1 to 2.3 ± 0.2 ×10-10 mol cm-2 min-1 after 4 h of release, indicating that the addition of Cu NPs can increase NO flux up to five times in the same 4 h period. Additionally, a 3-log reduction in S. aureus and 1-log reduction in P. aeruginosa was observed in viable bacterial adhesion over a 24 h period compared to control loops. A Cell Counting Kit-8 (CCK-8) assay was used to validate no overall cytotoxicity towards 3T3 mouse fibroblasts. Finally, extracorporeal circuits were coated and exposed to 4 h of blood flow under an in vivo rabbit model. The Cu GSNO combination was successful in maintaining 89.3% of baseline platelet counts, while the control loops were able to maintain 67.6% of the baseline. These results suggest that the combination of Cu NPs with GSNO increases hemocompatibility and antimicrobial properties of ECC loops without any cytotoxic effects towards mammalian cells.
Collapse
Affiliation(s)
- Megan E Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Marcus J Goudie
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Jitendra Pant
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Priyadarshini Singha
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Sean Hopkins
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Ryan Devine
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| | - Chad W Schmiedt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA
| |
Collapse
|