Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries

• Published in: Injury Vol. 54; no. 2; pp. 405 - 408
• Main Authors: Schweickhardt, Samantha K., Sams, Valerie G., Radowsky, Jason S., Sobieszczyk, Michal J., Marcus, Joseph E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2023
• Subjects: Adult; Antimicrobial stewardship; ECMO; Extracorporeal Membrane Oxygenation; Female; Humans; Infant, Newborn; Infections; Injury severity score; Male; Retrospective Studies; Trauma; ECMO; Infections; Antimicrobial stewardship; Injury severity score; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.11.048

•Extracorporeal membrane oxygenation (ECMO) is used with increased frequency for patients with traumatic injuries.•Infection rate (107.3 infections/100,000 ECMO days) is much greater than in other ECMO studies, with predominantly respiratory infections.•Gram-negative bacteria caused a majority of infections in this population regardless of time after cannulation or site.•Empiric antibiotics in trauma patients receiving ECMO with infections should cover Gram-negative bacteria.
Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO.
A chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation.
Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (90%) with a median age of 30 [IQR 27–38], and a median ECMO course of 9.8 days [IQR 3.9–14.1]. Motor vehicle crashes (81%) accounted for the majority of mechanisms of injury. Of the 24 infections, the majority were respiratory (n = 13, 58/1000 ECMO days) followed by skin and soft tissue (n = 6, 26/1000 ECMO days), blood stream (n = 4, 18/1000 ECMO days), and urinary tract (n = 1, 5/1000 ECMO days). Gram-negative bacteria were the most commonly isolated organism from all sites and at all time periods following cannulation. Multi-drug resistant organisms accounted for 35% (n = 9) of infections and were independent of time from cannulation.
This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Thus, with infection in this population, empiric antibiotics should have broad spectrum coverage of Gram-negative organisms.