Abstract
BackgroundLittle is known of nosocomial infections (NI) in patients who suffer from in-hospital cardiac arrest who undergoing extracorporeal cardiopulmonary resuscitation. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation.MethodsTo evaluate the incidence and clinical characteristics of NI in patients who undergoing extracorporeal cardiopulmonary resuscitation, a retrospective cohort study was conducted in a single tertiary referral center between January 2010 and December 2018. We included adult patients who undergoing extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest and excluded patients who were out-of-hospital cardiac arrest or failed ECMO implantation. Clinical characteristics and outcomes were compared between NI and Non-NI patients, or multidrug-resistant (MDR) and non-MDR. The independent risk factors associated with NIs were also analyzed using multivariable logistic regression model.ResultsThirty-five (23.3%) patients developed a NI. These cases included 21 patients with a gram negative (G-) infection, 12 patients with a gram positive (G+) bacterial infection, and two patients with fungal infection. Pneumonia was the most common type of NIs, followed by catheter-related infection. The in-hospital mortality and neurologic outcomes at discharge were not different between the NI and non-NI groups. Multidrug-resistant (MDR) pathogens were detected in 10 cases (28.6%). The MDR NI patients had a higher ICU mortality than did those with non-MDR NI (80% vs. 32%, p = 0.028). Following multivariable adjustment, body mass index (adjusted OR 0.87, 95% CI, 0.77–0.97, p = 0.016) and cardiopulmonary resuscitation to pump on time (adjusted OR 1.04, 95% CI, 1.01–1.06, p = 0.001) were independent predictors of NI development.ConclusionsIn patients who received extracorporeal cardiopulmonary resuscitation, NIs were not associated with an increase in in-hospital mortality. However, NIs with MDR organisms do increase the risk of in-hospital mortality. Lower body mass index and longer low flow time were significant predictors of NI development.
Highlights
Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest involves the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in addition to standard resuscitative efforts [1]
In patients who received extracorporeal cardiopulmonary resuscitation, nosocomial infections (NI) were not associated with an increase in in-hospital mortality
NIs with MDR organisms do increase the risk of in-hospital mortality
Summary
Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest involves the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in addition to standard resuscitative efforts [1]. The indwelling catheters that are used for veno-arterial ECMO can be risk factors for nosocomial infection (NI) development [3]. To date, only a few studies have evaluated the incidence, risk factors, microbial etiology, and antibiotic resistance patterns of NIs in patients with acute respiratory distress syndrome require prolonged support of veno-venous ECMO [7,8,9]. We sought to investigate the incidence, microbial etiology, resistance patterns, risk factors of NIs, and the association between NIs and clinical outcomes in in-hospital cardiac arrest (IHCA) patients who underwent ECPR. This study aimed to investigate clinical pictures of NI, and the association of NIs with clinical outcomes in in-hospital cardiac arrest patients who undergoing extracorporeal cardiopulmonary resuscitation
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