Infectious Disease Task Force
ELSO Task Force on Infectious Disease on ECMO: Diagnosis, Treatment and Prevention
In recognizing the importance and impact of infections on ECMO, the leadership of ELSO created the "Infectious Disease Task Force" in 2008 to address issues of diagnosis, treatment and prevention. This is summarized in the link below and the entire process, database review, explanation and support of the committee's recommendations are included in the new ELSO "Red Book" 2012.
In order to better disseminate information regarding Infectious Disease and Antibiotic therapy for ECMO patients, ELSO has created a network that will include a discussion board that can be accessed through the new ELSO website.
To review the ELSO database, the current literature, and current practices and with the assembled group of experts in both ECMO and infectious disease, make recommendations regarding the diagnosis of infections on ECMO, the treatment of Infections on ECMO, the prevention of infections on ECMO, as well as other related issues such as the safety of pre-primed circuits, prophylactic antibiotics, etc.
Mike Hines MD, FACS (Chair)
Ivor Berkowitz MD
Matthew Bizzarro MD
Kristina Bryant MD
Steven Conrad MD
Jim Fortenberry MD
Anna Karimova MD
David Kaufman MD
Bill Lynch MD
Preeti Malani MD
Allison Messina MD
Jason Newland MD
Jonathan Smith MD
Stephanie Stoyall MD
Hsin-Yu Sun MD
Enno Wildschut MD
Peter Rycus MPH
See Task Force summary attached below as well as detailed data in the new ELSO "Red Book" (2012).
The task force learned many things from the review of the database, including the fact that we need to collect more specific data. Specifically it is recommended that the ELSO database work to collect data on culture sites and culture dates to help define pre-existing infections from infections occurring on ECMO, particularly when it comes to resistant organisms (MRSA and VRE). It is currently not possible to distinguish patients colonized with these organisms, even prior to their becoming ill, and those who became colonized in the hospital while on ECMO, and those who were truly infected with these resistant organisms. Work also needs to be done to clarify the mode of ECMO support (better definitions provided), and to record when patients had open chests and open abdomens, and for how long. Additional data regarding severity of illness scores would also help with data analysis and outcomes.
The task force also concluded that further studies would be beneficial to define the pharmacokinetics of additional antibiotics. Research to try and define the role of inflammatory markers, including searching for new markers to assist in the identification of infection in this population would also be extremely beneficial.
Finally, the task force hopes that with implementation of its recommendations, a future study can demonstrate reduction in the rates of nosocomial infections, and perhaps lower mortality in those with sepsis.
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