Extracorporeal Life Support Center of Cardiovascular Surgery, Second Xiangya Hospital, Central South University, Changsha 410011.
Department of Medical Records Management, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Jun 28;47(6):748-754. doi: 10.11817/j.issn.1672-7347.2022.210472.
Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support strategy for the treatment of critically ill children with reversible heart and lung failure, increasingly being used in patients with low cardiac output after cardiac surgery. However, the mortality of patients is closely related to the complications of ECMO, especially bleeding, thrombosis, and infection, ECMO-related nosocomial infection has become a challenge to the success of ECMO. This study aims to analyze the incidence and risk factors for venoarterial-ECMO (VA-ECMO)-related nosocomial infections in children after cardiac surgery.
We retrospectively collected the data of patients who underwent VA-ECMO treatment after pediatric cardiac surgery in the Second Xiangya Hospital of Central South University from July 2015 to March 2021, and divided them into an infected group and a non-infected group. The clinical characteristics of the 2 groups of patients, VA-ECMO-related nosocomial infection factors, pathogenic microorganisms, and patient mortality were compared. Logistic regression was used to analyze the risk factors for nosocomial infection related to VA-ECMO after cardiac surgery.
Of the 38 pediatric patients, 18 patients (47.37%) had VA-ECMO related nosocomial infection, served as the infected group, including 7 patients with blood infections and 11 respiratory tract infections. Gram-negative pathogens (16 strains, 88.9%) were the main bacteria, such as (6 strains), (3 strains), and (3 strains). Compared with the non-infected group (=20), the infection group had longer time of cardiopulmonary bypass, time of myocardial block, and time of VA-ECMO assistance (All <0.05). Multivariate logistic regression analysis showed that time of cardiopulmonary bypass (OR=1.012, 95% CI 1.002 to 1.022; =0.021) was an independent risk factor for ECMO-related nosocomial infection. The number of surviving discharges in the infected group was less than that in the non-infected group (1 vs 11, <0.05).
Cardiopulmonary bypass time is an independent risk factor for VA-ECMO-related nosocomial infection in children after cardiac surgery. Shortening the duration of extracorporeal circulation may reduce the incidence of VA-EMCO-related nosocomial infections in children after cardic surgery. The occurrence of VA-ECMO-related nosocomial infections affects the number of patient's discharge alive.
体外膜肺氧合（ECMO）是治疗心肺衰竭的危重病儿的体外生命支持策略，越来越多地用于心脏手术后心输出量低的患者。然而，患者的死亡率与 ECMO 的并发症密切相关，尤其是出血、血栓形成和感染，ECMO 相关的医院内感染已成为 ECMO 成功的挑战。本研究旨在分析心脏手术后患儿静脉-动脉体外膜氧合（VA-ECMO）相关医院内感染的发生率和危险因素。
我们回顾性收集了 2015 年 7 月至 2021 年 3 月在中南大学湘雅二医院接受 VA-ECMO 治疗的小儿心脏手术后患者的数据，并将其分为感染组和非感染组。比较两组患者的临床特征、VA-ECMO 相关医院内感染因素、病原菌和患者死亡率。采用 logistic 回归分析心脏手术后 VA-ECMO 相关医院内感染的危险因素。
38 例患儿中，18 例（47.37%）出现 VA-ECMO 相关医院内感染，作为感染组，其中血感染 7 例，呼吸道感染 11 例。革兰阴性病原体（16 株，88.9%）是主要细菌，包括 （6 株）、 （3 株）和 （3 株）。与非感染组（=20）相比，感染组心肺转流时间、心肌阻断时间和 VA-ECMO 辅助时间更长（均<0.05）。多因素 logistic 回归分析显示，心肺转流时间（OR=1.012，95%CI 1.002 至 1.022；=0.021）是 ECMO 相关医院内感染的独立危险因素。感染组的存活出院人数少于非感染组（1 例比 11 例，<0.05）。
体外循环时间是小儿心脏手术后 VA-ECMO 相关医院内感染的独立危险因素。缩短体外循环时间可能降低小儿心脏手术后 VA-EMCO 相关医院内感染的发生率。VA-ECMO 相关医院内感染的发生影响患者存活出院的数量。
