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Updated: Aug 19, 2025
Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries
Samantha K Schweickhardt1, Valerie G Sams2, Jason S Radowsky2
1Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States.
Introduction:
Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO.
Methods:
A chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation.
Results:
Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (90%) with a median age of 30 [IQR 27-38], and a median ECMO course of 9.8 days [IQR 3.9-14.1]. Motor vehicle crashes (81%) accounted for the majority of mechanisms of injury. Of the 24 infections, the majority were respiratory (n = 13, 58/1000 ECMO days) followed by skin and soft tissue (n = 6, 26/1000 ECMO days), blood stream (n = 4, 18/1000 ECMO days), and urinary tract (n = 1, 5/1000 ECMO days). Gram-negative bacteria were the most commonly isolated organism from all sites and at all time periods following cannulation. Multi-drug resistant organisms accounted for 35% (n = 9) of infections and were independent of time from cannulation.
Discussion/Conclusion:
This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Thus, with infection in this population, empiric antibiotics should have broad spectrum coverage of Gram-negative organisms.
Insights
Infections in trauma patients on Extracorporeal Membrane Oxygenation (ECMO) are predominantly Gram-negative. Empiric antibiotic strategies should target these pathogens for effective treatment in critically injured patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Trauma Surgery
Background:
- Extracorporeal Membrane Oxygenation (ECMO) is increasingly used for adult trauma patients.
- Limited data exists on pathogens complicating ECMO in trauma, hindering empiric antibiotic choices.
Purpose of the Study:
- To characterize infection types in trauma patients supported by ECMO.
- To inform empiric antibiotic selection for this vulnerable population.
Main Methods:
- Retrospective chart review of trauma patients on ECMO (Feb 2013 - Jul 2021).
- Identification of pathogens by culture site and time to infection post-cannulation.
Main Results:
- 21 trauma patients received ECMO; most were male (90%) with median age 30.
- Respiratory infections were most common (58/1000 ECMO days), followed by skin/soft tissue, bloodstream, and urinary tract.
- Gram-negative bacteria predominated across all sites and time points; 35% of infections involved multi-drug resistant organisms.
Conclusions:
- This study is the first to detail infections in trauma patients on ECMO.
- Gram-negative infections are prevalent regardless of culture site or time post-cannulation.
- Empiric antibiotic therapy should provide broad-spectrum Gram-negative coverage.
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