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Fever following extracorporeal membrane oxygenation decannulation: Infection, thrombosis or just physiology?
Benjamin Assouline1, Gianlucca Belli1, Karim Dorgham2
1Sorbonne Université, Service de Médecine Intensive Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, France.
Purpose:
Fever is frequent after extracorporeal membrane oxygenation (ECMO) decannulation. We aimed to evaluate the incidence of post-decannulation fever and describe its causes.
Methods:
Adult ECMO patients who were successfully weaned from ECMO were retrospectively included. Minimal and maximal core temperatures were collected daily for each patient from 48 h before decannulation up to 5 days after. Patients were grouped according to the cause of fever (infection, thrombosis, or no evident cause) and compared. Plasma cytokine profile was obtained, each day from decannulation to 5 days after for 20 patients.
Results:
Between January 2021 and December 2022, 123 patients successfully weaned from ECMO were included. Post-decannulation fever occurred in 54 patients (44 %). It was associated with an infection in 39 patients (72 %) and with a thrombosis in 6 patients (11 %), and no cause was identified in the remaining 9 (17 %). Prolonged ECMO duration, extended ICU length-of-stay, diabetes and vascular comorbidities were significantly associated with a higher risk of infection. Finally, the pro-inflammatory cytokine profiles did not differ between febrile and afebrile patients.
Conclusion:
Post-decannulation fever was common, and was mainly due to infections or thrombosis. Fever should therefore not be considered as a benign inflammatory reaction until proven otherwise.
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