TY - JOUR
T1 - Single-center surgical site infection rate after peripheral ECMO decannulation and surgical repair
AU - Haddad, Paul
AU - Chasin, Cara
AU - Xu, Jiaqiong
AU - Peden, Eric
AU - Rahimi, Maham
N1 - © The Author(s), 2022.
PY - 2022
Y1 - 2022
N2 - OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is used to provide heart-lung bypass support in cases of acute respiratory and cardiac failure. The two main classifications of ECMO are venoarterial (VA) and venovenous (VV). After the patient recovers from an acute state, ECMO decannulation from the groin often requires femoral exploration and vessel repair. This study was performed to quantify the rate of surgical site infection (SSI) after ECMO decannulation.METHODS: Retrospective single-institutional review of patients requiring ECMO from January 2016 to October 2019 was conducted. The study examined incidence of SSI. We evaluated preoperative risk factors, VA
versus VV ECMO, Szilagyi infection score, and postoperative management.
RESULTS: Initial search began with 176 ECMO cases, of which 106 patients were deceased before development of any infection. Eighteen were eliminated because of central ECMO access, and four were lost to chart privacy. Of the 154 patients requiring femoral ECMO, 48 (31%) survived, with 22 VA and 26 VV ECMO. Twelve patients were classified as infected, resulting in an overall SSI rate of 25%. Surgical repair of the femoral arterial cannulation site was required in the 22 VA ECMO patients, and 10 of these became infected, resulting in an infection rate of 45%. The remaining two infected were VV ECMO and did not require surgery. The VV ECMO SSI rate was 7.7%. The infected group of VA ECMO consisted of eight primary surgical repairs and two patch repairs. Eight of the patients required multiple reoperations and two required antibiotics and wound care alone. There was no instance of limb loss. Statistical analysis showed intraoperative transfusion of >250 ml and blood loss of >300 ml as the only predictive factors of infection. The Szilagyi score was found to be worse in patients requiring patch angioplasty.CONCLUSION: Surgical repair of ECMO arterial cannulation sites had postoperative SSIs in nearly half of the patients (45%). The VV ECMO SSI rate was found to be 7.7%. Severity of infection was worse in more complicated repairs. Overall ECMO mortality was high at 69%. Although we found no clear correlation with common risk factors, transfusions >250 ml and blood loss >300 ml were found to be predictive. Vascular surgeons should be aware of high risk of SSI with repair of femoral ECMO cannulation sites.
AB - OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is used to provide heart-lung bypass support in cases of acute respiratory and cardiac failure. The two main classifications of ECMO are venoarterial (VA) and venovenous (VV). After the patient recovers from an acute state, ECMO decannulation from the groin often requires femoral exploration and vessel repair. This study was performed to quantify the rate of surgical site infection (SSI) after ECMO decannulation.METHODS: Retrospective single-institutional review of patients requiring ECMO from January 2016 to October 2019 was conducted. The study examined incidence of SSI. We evaluated preoperative risk factors, VA
versus VV ECMO, Szilagyi infection score, and postoperative management.
RESULTS: Initial search began with 176 ECMO cases, of which 106 patients were deceased before development of any infection. Eighteen were eliminated because of central ECMO access, and four were lost to chart privacy. Of the 154 patients requiring femoral ECMO, 48 (31%) survived, with 22 VA and 26 VV ECMO. Twelve patients were classified as infected, resulting in an overall SSI rate of 25%. Surgical repair of the femoral arterial cannulation site was required in the 22 VA ECMO patients, and 10 of these became infected, resulting in an infection rate of 45%. The remaining two infected were VV ECMO and did not require surgery. The VV ECMO SSI rate was 7.7%. The infected group of VA ECMO consisted of eight primary surgical repairs and two patch repairs. Eight of the patients required multiple reoperations and two required antibiotics and wound care alone. There was no instance of limb loss. Statistical analysis showed intraoperative transfusion of >250 ml and blood loss of >300 ml as the only predictive factors of infection. The Szilagyi score was found to be worse in patients requiring patch angioplasty.CONCLUSION: Surgical repair of ECMO arterial cannulation sites had postoperative SSIs in nearly half of the patients (45%). The VV ECMO SSI rate was found to be 7.7%. Severity of infection was worse in more complicated repairs. Overall ECMO mortality was high at 69%. Although we found no clear correlation with common risk factors, transfusions >250 ml and blood loss >300 ml were found to be predictive. Vascular surgeons should be aware of high risk of SSI with repair of femoral ECMO cannulation sites.
KW - ECMO
KW - Szilagyi score
KW - femoral artery repair
KW - surgical site infection
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U2 - 10.1177/20499361221132148
DO - 10.1177/20499361221132148
M3 - Article
C2 - 36311554
AN - SCOPUS:85140323126
SN - 2049-9361
VL - 9
SP - 20499361221132148
JO - Therapeutic Advances in Infectious Disease
JF - Therapeutic Advances in Infectious Disease
ER -