2012. A Descriptive Study of Infections Complicating Extracorporeal Membrane Oxygenations in Trauma Patients


 
 
 Extracorporeal Membrane Oxygenation (ECMO) is a growing modality for respiratory and circulatory support in patients with traumatic injuries. There is limited data on the pathogens complicating a trauma patient’s ECMO course and thus empiric antibiotic choices are difficult in this cohort. We report the incidence and infection type in trauma patients receiving ECMO to potentially guide future empiric antibiotic treatment and improve outcomes.
 
 
 
 A descriptive chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation. This protocol was approved by the 59th Medical Wing Institutional Review Board.
 
 
 
 Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (n=19, 90%) with a median age of 30 years [IQR 27-38] with a median ECMO run of 227 hours [IQR 93-338]. Motor vehicle crashes (17, 81%) accounted for the majority of injuries, with gunshot wounds (2, 10%), blast injuries (1, 5%) and falls (1, 5%) accounting for the remainder. 16 (76%) patients survived to discharge, and infection was not associated with mortality (p=0.11). Of the 24 infections, the majority were respiratory (13, 58/1000 ECMO days) followed by skin and soft tissue (6, 26/1000 ECMO days), blood stream (4, 18/1000 ECMO days), and urinary tract (1, 5/1000 ECMO days). Gram-negatives were the most commonly isolated organism from all sites (Table 1) and at all time periods after cannulation (Table 2). Multi-drug resistant organisms accounted for 32% (n=9) of infections and were independent of time from cannulation.
 
 
 
 This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Determining empiric antibiotics will require a larger study of patients to identify trends in pathogens and ultimately improve antimicrobial stewardship in this unique population.
 
 
 
 All Authors: No reported disclosures.
