TY - JOUR
T1 - A consensus of international experts on definition, sampling, treatment, and prevention of peripheral extracorporeal membrane oxygenation cannula-site infection obtained by the Delphi method
T2 - the SAVECMO study
AU - For EuroELSO
AU - Masi, Paul
AU - Abrams, Darryl
AU - Hssain, Ali Ait
AU - Balik, Martin
AU - Barrett, Nicholas A.
AU - Broman, Lars Mikael
AU - Camporota, Luigi
AU - Chen, Yih Sharng
AU - Combes, Alain
AU - De Backer, Daniel
AU - Del Sorbo, Lorenzo
AU - Diaz, Rodrigo
AU - Donker, Dirk W.
AU - Douflé, Ghislaine
AU - Fan, Eddy
AU - Fraser, John F.
AU - Giani, Marco
AU - Giraud, Raphael
AU - Grasselli, Giacomo
AU - Hraiech, Sami
AU - Lorusso, Roberto
AU - MacLaren, Graeme
AU - Marcus, Joseph E.
AU - Martucci, Gennaro
AU - Mendes, Pedro Vitale
AU - Ohshimo, Shinichiro
AU - Paiva, José Artur
AU - Park, Sunghoon
AU - Ramanathan, Kollengode
AU - Riera, Jordi
AU - Roncon-Albuquerque, Roberto
AU - Salazar, Leonardo
AU - Schmidt, Matthieu
AU - Shah, Aditya
AU - Shekar, Kiran
AU - Supady, Alexander
AU - Taccone, Fabio Silvio
AU - Tonna, Joseph E.
AU - Yeung Ng, Pauline
AU - Yusuff, Hakeem
AU - Luyt, Charles Edouard
N1 - Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2026.
PY - 2026/2
Y1 - 2026/2
N2 - 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.
AB - 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.
KW - Cannula-site infection (CSI)
KW - Definition
KW - Delphi
KW - Extracorporeal membrane oxygenation (ECMO)
KW - Prevention
KW - Treatment
UR - https://www.scopus.com/pages/publications/105027738121
U2 - 10.1007/s00134-025-08269-2
DO - 10.1007/s00134-025-08269-2
M3 - Article
C2 - 41504890
AN - SCOPUS:105027738121
SN - 0342-4642
VL - 52
SP - 263
EP - 277
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 2
ER -