Welcome to Our Survey

Infections (such as ventilator-associated pneumonia, blood stream infection, urinary tract infection, wound infection) acquired during Extracorporeal Life Support (ECLS) represent one of the most common ECLS complications[1-5]. Infection can lead to increased mortality and morbidity[5-8]. Infection prevention and early identification of infection, allowing prompt treatment, are therefore important strategies to achieve improved ECLS outcomes overall.

The identification and diagnosis of infection whilst on ECLS represents unique challenges. Whilst on ECLS, clinical signs of infection (such as temperature, blood pressure, heart rate, respiratory rate) are masked and often unreliable. ECLS therapy also provokes a systemic inflammatory response that leads to non-specific increases in the levels of traditional infection biomarkers[9-11]. This high risk of infection coupled with poor sensitivity and specificity of clinical signs and markers of infection may lead to a delay in identification and treatment of infection. At the same time, it may be associated with unnecessary use of antimicrobial therapy. Consensus guidelines acknowledge the lack of evidence to guide optimal management on patients on ECLS in relation to infection prevention, recognition and management[12].

This survey looks to assess the variability in practice of ECLS practitioners regarding strategies for infection prevention, surveillance investigations and thresholds for diagnosis. Completing the survey should take no more than 5 minutes.

All data will remain confidential and will be destroyed after analysis.

Thank you for your time.

Investigators:
Deborah Farrell, Lady Cilento Children’s Hospital, Brisbane, PICU
Graeme MacLaren, Royal Children’s Hospital, Melbourne, PICU
Luregn Schlapbach, Lady Cilento Children’s Hospital, Brisbane, PICU
 
The Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC) has approved this study.
HREC/17/QRCH/130

References:
1. Bizzarro, M.J., et al., Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr Crit Care Med, 2011. 12(3): p. 277-81.
2. Schmidt, M., et al., Nosocomial infections in adult cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Clin Infect Dis, 2012. 55(12): p. 1633-41.
3. O'Neill, J.M., et al., Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med, 2001. 27(8): p. 1247-53.
4. Haneke, F., et al., Infections and Extracorporeal Membrane Oxygenation: Incidence, Therapy, and Outcome. ASAIO J, 2016. 62(1): p. 80-6.
5. Brown, K.L., et al., Healthcare-associated infection in pediatric patients on extracorporeal life support: The role of multidisciplinary surveillance. Pediatr Crit Care Med, 2006. 7(6): p. 546-50.
6. Meyer, D.M., M.E. Jessen, and R.C. Eberhart, Neonatal extracorporeal membrane oxygenation complicated by sepsis. Extracorporeal Life Support Organization. Ann Thorac Surg, 1995. 59(4): p. 975-80.
7. Steiner, C.K., et al., Predictors of acquiring a nosocomial bloodstream infection on extracorporeal membrane oxygenation. J Pediatr Surg, 2001. 36(3): p. 487-92.
8. Gardner, A.H., et al., Fungal infections and antifungal prophylaxis in pediatric cardiac extracorporeal life support. J Thorac Cardiovasc Surg, 2012. 143(3): p. 689-95.
9. Rungatscher, A., et al., Diagnosis of infection in paediatric veno-arterial cardiac extracorporeal membrane oxygenation: role of procalcitonin and C-reactive protein. Eur J Cardiothorac Surg, 2013. 43(5): p. 1043-9.
10. Pieri, M., et al., Diagnosis of infection in patients undergoing extracorporeal membrane oxygenation: a case-control study. J Thorac Cardiovasc Surg, 2012. 143(6): p. 1411-6.
11. Tanaka, D., et al., Can procalcitonin differentiate infection from systemic inflammatory reaction in patients on extracorporeal membrane oxygenation? J Heart Lung Transplant, 2014. 33(11): p. 1186-8.
12. Extracorporeal Life Support Organisation Infectious Disease Task Force, Infection Control and Extracorporeal Life Support. 2012  [cited 2017; Available from: https://www.elso.org/Portals/0/Files/Infection-Control-and-Extracorporeal-Life-Support.pdf.

T