Haddad Paul, Chasin Cara, Xu Jiaqiong, Peden Eric, Rahimi Maham
Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA.
Department of Cardiovascular Surgery, Houston Methodist Hospital, 6565 Fannin St., Houston, TX 77030, USA.
Ther Adv Infect Dis. 2022 Oct 20;9:20499361221132148. doi: 10.1177/20499361221132148. eCollection 2022 Jan-Dec.
Extracorporeal membrane oxygenation (ECMO) is used to provide heart-lung bypass support in cases of acute respiratory and cardiac failure. The two main classifications of ECMO are venoarterial (VA) and venovenous (VV). After the patient recovers from an acute state, ECMO decannulation from the groin often requires femoral exploration and vessel repair. This study was performed to quantify the rate of surgical site infection (SSI) after ECMO decannulation.
Retrospective single-institutional review of patients requiring ECMO from January 2016 to October 2019 was conducted. The study examined incidence of SSI. We evaluated preoperative risk factors, VA VV ECMO, Szilagyi infection score, and postoperative management.
Initial search began with 176 ECMO cases, of which 106 patients were deceased before development of any infection. Eighteen were eliminated because of central ECMO access, and four were lost to chart privacy. Of the 154 patients requiring femoral ECMO, 48 (31%) survived, with 22 VA and 26 VV ECMO. Twelve patients were classified as infected, resulting in an overall SSI rate of 25%. Surgical repair of the femoral arterial cannulation site was required in the 22 VA ECMO patients, and 10 of these became infected, resulting in an infection rate of 45%. The remaining two infected were VV ECMO and did not require surgery. The VV ECMO SSI rate was 7.7%. The infected group of VA ECMO consisted of eight primary surgical repairs and two patch repairs. Eight of the patients required multiple reoperations and two required antibiotics and wound care alone. There was no instance of limb loss. Statistical analysis showed intraoperative transfusion of >250 ml and blood loss of >300 ml as the only predictive factors of infection. The Szilagyi score was found to be worse in patients requiring patch angioplasty.
Surgical repair of ECMO arterial cannulation sites had postoperative SSIs in nearly half of the patients (45%). The VV ECMO SSI rate was found to be 7.7%. Severity of infection was worse in more complicated repairs. Overall ECMO mortality was high at 69%. Although we found no clear correlation with common risk factors, transfusions >250 ml and blood loss >300 ml were found to be predictive. Vascular surgeons should be aware of high risk of SSI with repair of femoral ECMO cannulation sites.
体外膜肺氧合（ECMO）用于在急性呼吸和心力衰竭病例中提供心肺旁路支持。ECMO的两种主要分类是静脉-动脉（VA）和静脉-静脉（VV）。患者从急性期恢复后，经腹股沟拔除ECMO导管通常需要进行股部探查和血管修复。本研究旨在量化ECMO导管拔除术后手术部位感染（SSI）的发生率。
对2016年1月至2019年10月期间需要ECMO的患者进行回顾性单机构研究。该研究检查了SSI的发生率。我们评估了术前危险因素、VA与VV ECMO、齐拉吉感染评分以及术后管理。
初始搜索从176例ECMO病例开始，其中106例患者在发生任何感染之前死亡。18例因中心ECMO通路被排除，4例因病历隐私问题失访。在154例需要股部ECMO的患者中，48例（31%）存活，其中22例为VA ECMO，26例为VV ECMO。12例患者被归类为感染，总体SSI发生率为25%。22例VA ECMO患者需要对股动脉插管部位进行手术修复，其中10例发生感染，感染率为45%。其余2例感染患者为VV ECMO，不需要手术。VV ECMO的SSI发生率为7.7%。VA ECMO感染组包括8例初次手术修复和2例补片修复。8例患者需要多次再次手术，2例仅需要抗生素和伤口护理。没有肢体丢失的情况。统计分析显示术中输血>250ml和失血>300ml是唯一的感染预测因素。发现需要补片血管成形术的患者齐拉吉评分更差。
ECMO动脉插管部位的手术修复在近一半的患者（45%）中发生了术后SSI。发现VV ECMO的SSI发生率为7.7%。在更复杂的修复中感染的严重程度更差。总体ECMO死亡率很高，为69%。虽然我们没有发现与常见危险因素有明确关联，但发现输血>250ml和失血>300ml具有预测性。血管外科医生应意识到修复股部ECMO插管部位时SSI的高风险。
