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Chest ; 162(4):A939-A940, 2022.
Article in English | EMBASE | ID: covidwho-2060734


SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Utilization of ECMO support for refractory cardiogenic, and respiratory failure has increased exponentially over the last 20 years. The advent of miniaturized and portable machines has led to a shift of cannulation strategies in the operating room/cath lab to the bedside. Transitioning to bedside cannulation has been previously reported as safe, with minimal risk for mortality or catheter site infections. However, bedside cannulations in the critically ill crashing patient raises concern for sterility. The aim of this study was to assess the risk of ECMO cannula site infections in bedside vs operating room/catheterization suite. METHODS: It is a retrospective single institution case series review of 52 adult and pediatric patients who were required either Veno-Venous (VV) or Veno-Arterial (VA) ECMO. Data gathering was used to quantify the rate of catheter site infections after initiation of extracorporeal support. Catheter site infections were defined as localized erythema, fluctuance, or purulence from the cannula site within 7 days of of ECMO cannula placement. RESULTS: A total of 42 (81%) pts had bedside cannulation, and the other 10 (19%), were done in IR suite/cath lab. The total number of catheter site infections was 1 (2.4%) in the bedside cannulation group. There were no infections in the non-bedside cannulation groups. 13 (30%) of the bedside cannulations, and 3 (30%) of the non-bedside cannulation group were on antibiotics during or prior to cannula insertion. CONCLUSIONS: Current literature suggests that the prevalence of infections on ECMO is 10-12%,. Traditionally, this has predisposed most cannulations to be performed in the surgical setting rather than at bedside. During the recent COVID pandemic, the frequency of bedside cannulation for ECMO had increased and was not associated with significant morbidity, and mortality. The risk of infection from the catheter site had also been determined to be minimal to none. From the data gathered above, it can be safely assumed that the risk of catheter site infection with bedside cannulation is minimal. However, the major contributing factor to decreased infection risk appears to be meticulous cannula site nursing care. The current ECMO nursing protocol utilized at our hospital required twice daily dressing changes with stringent chlorhexidine cleanses prior to redressing. The only case of catheter site infection we experienced was when this protocol was deviated. CLINICAL IMPLICATIONS: Utilizations of bedside ECMO cannulation techniques carries minimal risk for catheter site infections. It is important to state that nursing driven protocols for cannula site dressing changes, has one of the biggest implications on the risk of catheter site infections. Therefore, with the employment of appropriate nursing protocols, the concern for catheter site infections should not preclude the decision to proceed with bedside cannulation. DISCLOSURES: No relevant relationships by Ajit Alexander No relevant relationships by Melodie Blackmon Scientific Medical Advisor relationship with ALung Technologies, Inc. Please note: $5001 - $20000 by Steven Conrad, value=Consulting fee No relevant relationships by ANIBAL DOMINGUEZ no disclosure on file for Jonathan Eaton;No relevant relationships by Laurie Grier No relevant relationships by Rajkamal Hansra No relevant relationships by Prathik Krishnan No relevant relationships by Nathaniel LSUHSC-Shreveport No relevant relationships by Alex Manuel No relevant relationships by Jonathan Packer No relevant relationships by arunima sharma no disclosure on file for Chris Trosclair;No relevant relationships by Gregory Vo No relevant relationships by Robert Walter

ASAIO Journal ; 68(Supplement 3):68, 2022.
Article in English | EMBASE | ID: covidwho-2058158


Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment modality for patients with severe respiratory and cardiac failure. During the COVID-19 pandemic, the ability to utilize this service worldwide was limited by the number of facilities capable of providing ECMO support and their patient capacity. We describe an institution rapidly deploying an ECMO transport program to improve access to this service and optimize its capacity. As the only ELSO Center of Excellence in the state of Louisiana, and one of the few facilities that can provide this service in the state, our center had an obligation to expand our ability to provide access to ECMO support in our region. However, as we had not performed ECMO transport before the pandemic, we were faced with challenges in developing the infrastructure for a transport program. Due to limited resources and our emphasis on treating the maximum number of patients, we had to create and implement protocols simultaneously, refining them as we went. We relied on programs that had previously developed transport protocols and procedures for guidance, adapting their templates for our program's specific characteristics. Less than one month after obtaining our first CardiohelpTM system we performed our first ECMO transport by air. Over the next twelve months, we performed more than ten transports by air and ground successfully with no mortalities or complications during transport. Despite various obstacles, we succeeded in creating a transport service and improved our ability to provide ECMO support to patients throughout the state of Louisiana.