Objective: Infection during mechanical circulatory support is a frequent adverse complication. We analyzed infections occurring in this population in a national tertiary care center, and assessed the differences existing between the setting of extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs). Design, setting, and participants: An observational study was made of patients treated with ECMO or VAD in the San Raffaele Scientific Institute (Italy) between 2009 and 2011. Interventions: None. Results: Thirty-nine percent of the 46 patients with ECMO and 69% of the 15 patients with VAD developed infection. We observed a mortality rate of 36.1% during mechanical circulatory support and of 55.7% during the global hospitalization period. Although Gram-negative infections were predominant overall, patients with ECMO were more prone to develop Candida infection (29%), and patients with VAD tended to suffer Staphylococcus infection (18%). Patients with infection had longer ECMO support ( p= 0.03), VAD support ( p= 0.01), stay in the intensive care unit ( p= 0.002), and hospital admission ( p= 0.03) than patients without infection.Infection (regression coefficient. = 3.99, 95% CI 0.93-7.05, p= 0.02), body mass index (regression coefficient. = 0.46, 95% CI 0.09-0.83, p= 0.02), fungal infection (regression coefficient. = 4.96, 95% CI 1.42-8.44, p= 0.009) and obesity (regression coefficient. = 10.47, 95% CI 1.77-19.17, p= 0.02) were predictors of the duration of ECMO support. Stepwise logistic regression analysis showed the SOFA score at the time of implant (OR. = 12.33, 95% CI 1.15-132.36, p= 0.04) and VAD (OR. = 1.27, 95% CI 1.04-1.56, p= 0.02) to be associated with infection. Conclusions: Infection is a major challenge during ECMO and VAD support. Each mechanical circulatory support configuration is associated with specific pathogens; fungal infections play a major role.
- Extracorporeal membrane oxygenation
- Ventricular assist devices
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine