Nosocomial Infections in Trauma Patients Receiving Extracorporeal Membrane Oxygenation

Background: The risk of infections in acute trauma patients receiving extracorporeal membrane oxygenation (ECMO) has not been well defined, but this population is among the sickest in the hospital. This study characterizes the blood and respiratory pathogens in trauma patients receiving ECMO and tests the hypothesis that trauma patients receiving ECMO pose a unique risk for nosocomial infections. Methods: All trauma patients (n = 50) who required ECMO at a level 1 trauma center between July 2014 and September 2023 were retrospectively reviewed. Blood and respiratory samples were examined for pathogens. Burn injuries were excluded from this study. Results: Most were male (88%) and sustained blunt injuries (60%), of which the most common mechanism was motor vehicle collision (37%). The median intensive care unit (ICU) length of stay was 26 days (interquartile range [IQR]: 12-54), median ventilator days was 22 (IQR: 9-51), and median length of ECMO treatment was eight days (IQR: 4-18). The most common ECMO type was veno-venous (80%). Blood stream and/or respiratory infections were detected in 22 (44%) patients. The most common was respiratory infection (70.2%). Gram-negative pathogens were most common in both blood stream (53.3%) and respiratory infections (75%). Among the blood stream pathogens, 20% were multi-drug resistant. Among the respiratory pathogens, 41.7% were multi-drug resistant. The median number of days from ECMO cannulation to blood stream infection was 10 days (IQR: 4-16) and the median number of days to respiratory infection was seven days (IQR: 3-11). Mortality was 22.7% (n = 5) among patients who had a respiratory and/or blood stream infection and 60% (n = 17) in ECMO patients who had no infection (p = 0.007). Conclusion: Almost half of trauma patients receiving ECMO had nosocomial infections, which is comparable with the infection rate of trauma patients in the ICU not on ECMO. Larger studies are needed to further assess infection risk in these patients and provide guidelines to mitigate this risk.