Retrospective Analysis of Multi-drug Resistant Gram-negative Bacteria on Veno-venous Extracorporeal Membrane Oxygenation. The Multicenter Ranger Study.

Abstract

Background: Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug resistant (MDR) bacteria before V-V ECMO placement. Our study aims to investigate: i) the occurrence of MDR Gram-negative (GN) bacteria in a cohort of V-V ECMOs; ii) the risk of 1-year mortality; and iii) the impact of annual hospital V-V ECMO volume on the probability of acquiring MDR GN bacteria. Methods: All consecutive adults admitted to the Intensive Care Units of 5 Italian university-affiliated hospitals and requiring V-V ECMO were screened. Exclusion criteria were age < 18 years, pregnancy, veno-arterial or mixed ECMO-configuration, incomplete records, survival < 24 hours after V-V ECMO placement. A routine protocol of microbiological surveillance was applied and MDR profiles were identified using in vitro susceptibility tests. Results: Two hundred and seventy-nine V-V ECMO patients (72% male) were enrolled. The overall MDR GN bacteria percentage was 50%: 21% (n. 59) detected before and 29% (n. 80) after V-V ECMO placement. The overall 1-year mortality was 42%, with a higher risk observed in precolonized patients (aOR 2.14 [1.33-3.47], p-value 0.002), while not in ‘V-V ECMO-acquired MDR GN bacteria’ group (aOR 1.51 [0.94-2.42], p-value 0.090), as compared to ‘non-MDR GN bacteria’ group (reference). A larger annual hospital V-V ECMO volume was associated with a lower probability of acquiring MDR GN bacteria during V-V ECMO course (aOR 0.91 [0.86-0.97], p-value 0.002). Conclusions: The occurrence of MDR GN bacteria was 21% before and 29% after V-V ECMO connection. A history of MDR GN bacteria, before V-V ECMO, was an independent risk factor for mortality. The annual hospital V-V ECMO volume affected the probability of acquiring MDR GN bacteria. TRIAL REGISTRATION: ClinicalTrial.gov registration number NCTNCT06199141, date 12.26.2023.