A consensus of international experts on definition, <underline>s</underline>ampling, treatment, <underline>a</underline>nd pre<underline>v</underline>ention of peripheral <underline>e</underline>xtra<underline>c</underline>orporeal <underline>m</underline>embrane <underline>o</underline>xygenation cannula-site infection obtained by the Delphi method: the SAVECMO study

BackgroundNosocomial 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.MethodsWe 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.ResultsThe 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.ConclusionThis 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.