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Updated: Jun 18, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Outcome of extracorporeal membrane oxygenation support among children with methicillin-resistant Staphylococcus
Mitchell A Luangrath1, Madhuradhar Chegondi1, Aditya Badheka1
1Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Health Care, Iowa City, IA, USA.
Insights
Pediatric patients with methicillin-resistant Staphylococcus aureus (MRSA) infection on extracorporeal membrane oxygenation (ECMO) had low survival rates at our institution. While 62.5% were decannulated, only two patients survived to discharge, highlighting the need for further research.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- Extracorporeal membrane oxygenation (ECMO) use in children is increasing, including for methicillin-resistant Staphylococcus aureus (MRSA) infections.
- Survival rates for pediatric patients with MRSA sepsis have remained stagnant over the past two decades.
- Understanding outcomes for pediatric MRSA patients on ECMO is crucial.
Purpose of the Study:
- To review institutional experience and outcomes of pediatric patients with MRSA infection undergoing ECMO support.
- To identify factors influencing survival in this patient population.
Main Methods:
- Retrospective review of pediatric patients (0-19 years) who received ECMO from October 2014 to June 2021.
- Identification of patients with laboratory-confirmed MRSA infections.
- Analysis of ECMO duration, mechanical ventilation, cannulation type, and survival to discharge.
Main Results:
- Eight of 88 pediatric ECMO patients had documented MRSA infections.
- Median ECMO duration was 648.1 hours; average pre-ECMO ventilation was 7 days.
- Only two of eight patients survived to discharge; both received VV-ECMO support.
- Five patients (62.5%) were successfully decannulated.
Conclusions:
- Institutional survival for pediatric MRSA patients on ECMO is lower than reported in recent studies.
- VV-ECMO was used in both surviving patients, but no other clear survival trends were identified.
- MRSA infection remains a significant cause of morbidity and mortality in pediatric ECMO patients, warranting further investigation.
Abstract:
Introduction: The use of extracorporeal membrane oxygenation (ECMO) in children continues to increase nationally, including patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Survival of pediatric patients with MRSA sepsis has not improved over the last 20 years. We sought to review our institutional experience and outcomes of ECMO support among children with MRSA infection.Methods: Children aged 0-19 years who received ECMO support from October 2014 to June 2021 were reviewed retrospectively. Patients with laboratory confirmed MRSA infections were identified.Results: Out of 88 unique pediatric patients requiring ECMO support, eight patients had documented MRSA infections. The duration of mechanical ventilation prior to ECMO initiation was an average of seven days (range 0.7 to 21.8 days). The median ECMO duration was 648.1 h (range 15.5 to 1580.5 h). Five patients were successfully decannulated; however, only two patients survived to discharge. The two surviving patients were both cannulated via VV-ECMO. Mechanical ventilation prior to ECMO was 4.5 and 21.8 days in these cases with run durations of 18.9 and 29.9 days, respectively.Conclusions: Our institutional survival of patients with MRSA on ECMO is lower than what has been reported in recent database studies, but notably, 62.5% were successfully decannulated. While both surviving patients were supported with VV-ECMO, there was no other clear trend in factors that contributed to survival. MRSA continues to be a source of significant morbidity and mortality among pediatric patients. On-going investigation of outcomes and factors contributing to survival in patients with MRSA infection on ECMO is warranted.
