ECMO specialist’ challenges towards acquired infections during extracorporeal membrane oxygenation: An international qualitative ECMO infection study

Background

Despite the life-saving potential of Extracorporeal Membrane Oxygenation (ECMO), it is not without significant challenges, particularly those associated with acquired infections during treatment. The purpose of this study was to explore the challenges that ECMO specialists faced regarding acquired infections by ECMO patients.

Methods

This qualitative study involved 19 ECMO specialists from around the world, representing key disciplines in ECMO care-including critical care physicians, ECMO nurses, respiratory therapists, microbiologists, cardiologists, cardiac surgeons, and perfusionists. All participants had at least five years of dedicated ECMO experience. Purposive sampling was conducted between August and December 2024. Data were collected through in-depth, semi-structured interviews with open-ended questions and analyzed using conventional content analysis.

Results

Data analysis revealed two principal themes regarding acquired infections in ECMO patients. The first theme, perceived challenges, encompassed the unique nature of ECMO-including its novel science, diverse cannulas and catheters, and varied equipment-alongside a lack of consensus on infection indicators, such as non-specific laboratory tests, absence of a unified infection definition, and scarce clinical signs. Additional challenges involved reliance on clinical experience over robust evidence, limited international guidelines, and patient-specific factors. The second theme focused on infection management strategies, emphasizing patient-centered care, family involvement, promotion of evidence via scientific meetings and prospective studies, prevention through adherence to aseptic principles, and strengthening multidisciplinary teamwork.

Conclusion

The challenges of acquired infections are one of the most important problems of patients undergoing ECMO, and of course, the approaches to its prevention are evolving.

Implication for Clinical Practice

The findings show that acquired infections in ECMO patients are a serious challenge requiring patient-centered and team-based care. Clearer clinical guidelines are needed for infection detection and prevention. Focusing on prevention, continuous education, and enhancing teamwork can improve treatment outcomes. Strengthening scientific evidence is also essential for clinical decision-making.