Infectious Complications under ECMO

Abstract

Although major advances in management of extra-corporeal membrane oxygenation (ECMO) patients have been made in the last decade, the short-term mortality remains important. The high incidence of nosocomial infections during ECMO largely contributes to this poor outcome. Alterations of the immune system, canulation of great vessels and insertion of many invasive devices, consitute multiple entry routes for pathogens and could consequently increase the risk for nosocomial infections. They are mainly due to ventilator-associated pneumonia, and canula infections. The risk of nosocomial infections increases with patient’sseverity at ICU admission, as well as with a longer duration of ECMO support. Early detection of these infections is of great importance, while often difficult because of confounding factors induced by the device. Clinicians have to be aware of specific considerations relative to the management of infections’ prevention, diagnosis and treatment on ECMO. Research on preventive strategies aiming at reducing the burden of nosocomial infections during ECMO is now warranted.