体外膜肺氧合支持患者感染的回顾性研究。
A Retrospective Study of Infection in Patients Requiring Extracorporeal Membrane Oxygenation Support.
机构信息
Center for Trauma and Critical Care, Department of Surgery, George Washington University School of Medicine, Washington DC.
Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland.
出版信息
Ann Thorac Surg. 2021 Oct;112(4):1168-1175. doi: 10.1016/j.athoracsur.2020.12.012. Epub 2020 Dec 24.
BACKGROUND
Healthcare-associated infections (HAIs) in critically ill patients are a serious public health problem. Extracorporeal membrane oxygenation (ECMO) has been used increasingly for patients with severe cardiac or respiratory failure, but it may increase HAI risk. The goal of our study was to characterize HAIs in ECMO patients at an ECMO referral center.
METHODS
This institutional review board-approved study identified all consecutive adult ECMO patients admitted to the cardiac surgery intensive care unit (CSICU) between January 1, 2015, and December 31, 2017. Demographic data, diagnosis, ECMO cannulation technique, and survival were collected. Urinary tract infection, pneumonia, and bacteremia incidence during ECMO and within 3 months of decannulation were collected. Outcomes of patients with HAIs were compared with noninfected patients, the CSICU infection incidence, and overall Extracorporeal Life Support Organization survival data.
RESULTS
There were 288 ECMO patients and 3396 CSICU admissions during this period. Survival was 72.3% for venoarterial ECMO, 85.3% for venovenous ECMO, and 57.1% for multimodality or veno-arteriovenous ECMO, with discharge survival of 60.2%, 72.0%, and 28.6%, respectively. Bacteremia incidence while cannulated was 6.8% for venoarterial ECMO and 9.3% for venovenous ECMO. Bacteremia occurred in 22 of 288 (7.6%) ECMO patients, compared with 48 of 3109 (1.5%) in non-ECMO CSICU patients, which was statistically significant (P < .002). Bacteremia and pneumonia were associated with decreased VA-ECMO survival, with prolonged overall requirements for ECMO support.
CONCLUSIONS
Nosocomial ECMO infections are significantly higher than in other CSICU patients. Infection risk remains significant even after decannulation. Infection is associated with increased mortality and longer duration of ECMO support. Further efforts are needed to determine HAI reduction strategies in this high-risk patient population.
背景
危重症患者的医源性感染（HAI）是一个严重的公共卫生问题。体外膜肺氧合（ECMO）已越来越多地用于治疗严重的心脏或呼吸衰竭患者，但它可能会增加 HAI 的风险。我们的研究目的是描述 ECMO 转介中心 ECMO 患者的 HAI 特征。
方法
这项经机构审查委员会批准的研究纳入了 2015 年 1 月 1 日至 2017 年 12 月 31 日期间入住心脏外科重症监护病房（CSICU）的所有连续成年 ECMO 患者。收集人口统计学数据、诊断、ECMO 插管技术和生存情况。收集 ECMO 期间和拔管后 3 个月内的尿路感染、肺炎和菌血症发生率。将 HAI 患者的结局与未感染患者、CSICU 感染发生率和整体体外生命支持组织的生存数据进行比较。
结果
在此期间，共有 288 例 ECMO 患者和 3396 例 CSICU 住院患者。静脉-动脉 ECMO 的存活率为 72.3%，静脉-静脉 ECMO 的存活率为 85.3%，多模式或静脉-动静脉 ECMO 的存活率为 57.1%，出院存活率分别为 60.2%、72.0%和 28.6%。静脉-动脉 ECMO 的菌血症发生率为 6.8%，静脉-静脉 ECMO 的菌血症发生率为 9.3%。288 例 ECMO 患者中有 22 例（7.6%）发生菌血症，3109 例非 ECMO CSICU 患者中有 48 例（1.5%）发生菌血症，差异有统计学意义（P<.002）。菌血症和肺炎与 VA-ECMO 存活率降低有关，并且需要更长时间的 ECMO 支持。
结论
医院获得性 ECMO 感染明显高于其他 CSICU 患者。即使在拔管后，感染风险仍然很高。感染与死亡率增加和 ECMO 支持时间延长有关。需要进一步努力确定这一高危患者群体的 HAI 降低策略。
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