Extracorporeal Support

Infections on Extracorporeal Life Support in Adults and Children—A Survey of International Practice on Prevention, Diagnosis, and Treatment*

Farrell, Deborah MBBS^1,2; MacLaren, Graeme MBBS, MSc, FCICM^3,4; Schlapbach, Luregn J. MD, FCICM^1,2,5

¹Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.

²Paediatric Intensive Care Unit, Division of Critical Care, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane, QLD, Australia.

³Department of Pediatrics, Paediatric Intensive Care Unit, Royal Children’s Hospital, University of Melbourne, Parkville, VIC, Australia.

⁴Cardiothoracic Intensive Care Unit, National University Health System, Singapore.

⁵Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.

*See also p. 684.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Schlapbach is supported by a Practitioner Fellowship of the National Health and Medical Research Council of Australia and New Zealand and by the Children`s Hospital Foundation, Brisbane, Australia. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 20(7):p 667-671, July 2019. | DOI: 10.1097/PCC.0000000000001941

Abstract

Objectives:

To assess nosocomial infection management practices in pediatric and adult patients supported with extracorporeal life support.

Design:

A 23-question online survey was developed to assess practices related to infection prevention, surveillance, diagnosis, and treatment in patients managed on extracorporeal life support. The survey was distributed internationally to intensivists via online newsletters and e-mail from June to December 2017.

Setting:

Extracorporeal life support centers.

Subjects:

Intensivists working in extracorporeal life support centers.

Interventions:

None.

Results:

We analyzed 147 responses from 25 countries. Most centers have bundles implemented as standard of care to prevent against ventilator-associated pneumonia (77%) and central catheter–associated bloodstream infections (91%). Prophylactic antibiotics beyond cannulation are at least occasionally used by 61% of respondents. Daily C-reactive protein (35%) and white cell count (80%) are the most commonly used surveillance biomarkers, and 25% of respondents reported collecting daily surveillance cultures. Participants responded that new onset of hemodynamic instability and rising C-reactive protein (49%) or rising procalcitonin (30%) are the most common triggers to commence antibiotics.

Conclusion:

There is considerable variability surrounding practices on prevention and diagnosis of infection in patients treated with extracorporeal life support. In view of the impact of infections acquired during extracorporeal life support, further research to inform recommendations on prevention, diagnosis, and management of infection on extracorporeal life support is urgently needed.

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Infections on Extracorporeal Life Support in Adults and Children—A Survey of International Practice on Prevention, Diagnosis, and Treatment*