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Background <p>Nosocomial infections are common in patients receiving extracorporeal membrane oxygenation (ECMO), with ECMO cannula-site infections (ECMO-CSI) being the most frequent infections directly related to the ECMO run. These infections can significantly impact patient outcomes. Currently, no adult guidelines exist for the prevention, diagnosis, and/or treatment of peripheral ECMO-CSI, resulting in heterogeneity in both clinical practice and research findings.</p> Methods <p>We conducted a Delphi study involving 39 international experts in ECMO management. The experts participated in four Delphi rounds to reach consensus on various aspects of ECMO-CSI complicating peripheral ECMO (central ECMO excluded), including definition, clinical suspicion, diagnostic methods, preventive measures, and treatment. Consensus was defined as ≥ 70% agreement among experts on each proposed item.</p> Results <p>The Delphi process established consensus on key aspects of ECMO-CSI. Experts agreed on clinical scenarios that warrant suspicion of ECMO-CSI, such as purulent discharge and local inflammatory signs. Standardized sampling techniques, including swabs and purulent drainage aspiration, were recommended, while others were rejected. Definitions were clarified, specifying that ECMO-CSI is defined by the isolation of a pathogen through local microbiological sampling and the presence of purulent discharge or local inflammatory signs. Among the preventive measures, the use of chlorhexidine-impregnated or semipermeable polyurethane dressings, unchanged for 7&#xa0;days unless soiled or bleeding, was recommended, whereas systematic antibiotic prophylaxis, even for surgical ECMO, was not recommended.</p> Conclusion <p>This study presents an international expert consensus focusing on peripheral ECMO-CSI, providing a standardized framework to improve clinical management and facilitate future research. The consensus aims to enhance patient outcomes and support evidence-based guidelines in this complex field.</p>

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A consensus of international experts on definition, sampling, treatment, and prevention of peripheral extracorporeal membrane oxygenation cannula-site infection obtained by the Delphi method: the SAVECMO study

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Paul Masi,
  • Darryl Abrams,
  • Ali Ait Hssain,
  • Martin Balik,
  • Nicholas A. Barrett,
  • Lars Mikael Broman,
  • Luigi Camporota,
  • Yih-Sharng Chen,
  • Alain Combes,
  • Daniel De Backer,
  • Lorenzo Del Sorbo,
  • Rodrigo Diaz,
  • Dirk W. Donker,
  • Ghislaine Douflé,
  • Eddy Fan,
  • John F. Fraser,
  • Marco Giani,
  • Raphael Giraud,
  • Giacomo Grasselli,
  • Sami Hraiech,
  • Roberto Lorusso,
  • Graeme MacLaren,
  • Joseph E. Marcus,
  • Gennaro Martucci,
  • Pedro Vitale Mendes,
  • Shinichiro Ohshimo,
  • José-Artur Paiva,
  • Sunghoon Park,
  • Kollengode Ramanathan,
  • Jordi Riera,
  • Roberto Roncon-Albuquerque Jr.,
  • Leonardo Salazar,
  • Matthieu Schmidt,
  • Aditya Shah,
  • Kiran Shekar,
  • Alexander Supady,
  • Fabio Silvio Taccone,
  • Joseph E. Tonna,
  • Pauline Yeung Ng,
  • Hakeem Yusuff,
  • Charles-Edouard Luyt

摘要

Background

Nosocomial infections are common in patients receiving extracorporeal membrane oxygenation (ECMO), with ECMO cannula-site infections (ECMO-CSI) being the most frequent infections directly related to the ECMO run. These infections can significantly impact patient outcomes. Currently, no adult guidelines exist for the prevention, diagnosis, and/or treatment of peripheral ECMO-CSI, resulting in heterogeneity in both clinical practice and research findings.

Methods

We conducted a Delphi study involving 39 international experts in ECMO management. The experts participated in four Delphi rounds to reach consensus on various aspects of ECMO-CSI complicating peripheral ECMO (central ECMO excluded), including definition, clinical suspicion, diagnostic methods, preventive measures, and treatment. Consensus was defined as ≥ 70% agreement among experts on each proposed item.

Results

The Delphi process established consensus on key aspects of ECMO-CSI. Experts agreed on clinical scenarios that warrant suspicion of ECMO-CSI, such as purulent discharge and local inflammatory signs. Standardized sampling techniques, including swabs and purulent drainage aspiration, were recommended, while others were rejected. Definitions were clarified, specifying that ECMO-CSI is defined by the isolation of a pathogen through local microbiological sampling and the presence of purulent discharge or local inflammatory signs. Among the preventive measures, the use of chlorhexidine-impregnated or semipermeable polyurethane dressings, unchanged for 7 days unless soiled or bleeding, was recommended, whereas systematic antibiotic prophylaxis, even for surgical ECMO, was not recommended.

Conclusion

This study presents an international expert consensus focusing on peripheral ECMO-CSI, providing a standardized framework to improve clinical management and facilitate future research. The consensus aims to enhance patient outcomes and support evidence-based guidelines in this complex field.