Prevalence and microbiological profile of septic complications following ECMO decannulation: a prospective single-center study

Extracorporeal membrane oxygenation (ECMO) is widely used to manage acute respiratory distress syndrome (ARDS); however, biofilm formation on cannulas may contribute to infections. This study investigated the prevalence, timing, and microbial profiles of infectious complications following ECMO decannulation. This prospective, single-center cohort study was conducted in the mixed medical-surgical intensive care unit (ICU) at the University Hospital Essen (01/2022–01/2023). Adults who received ECMO for > 48 h were included. Microbiological sampling (blood cultures and wound swabs) was performed before and after decannulation. Cannulas were assessed for biofilms, and plasma samples were analyzed using next-generation sequencing (NGS) of microbial cell-free DNA (cfDNA). Sepsis was defined according to the most recent Sepsis-3 criteria. The study included 18 patients (56% men); 17 received VV-ECMO and one received VA-ECMO. Post-decannulation sepsis occurred in 10 of 18 patients (56%; 95% CI: 31–79%), and overall infectious complications were observed in 72% of patients. A strong negative correlation was evident between pre-ECMO ventilation duration and biofilm-forming bacteria in the blood during ECMO (r = − 0.7, p = 0.002). Blood cultures obtained within 10 min of decannulation were positive in 6 of 18 (33%) patients. NGS identified pathogens in 9 of 12 patients (75%), with 5 (42%) revealing additional organisms not detected by conventional methods. Viral pathogens were detected in 3 of 12 (25%) patients using NGS. Patients with sepsis demonstrated higher antibiotic consumption (p = 0.012) and more frequently met SOFA-based sepsis criteria (p = 0.007), whereas other parameters were comparable. Sepsis and infection frequently occur after ECMO decannulation and may be associated with biofilm-related pathogens. NGS has improved pathogen detection beyond standard diagnostics, although the findings require clinical correlation. These prospective findings support the need for further investigation of advanced integrated microbiological surveillance post-ECMO in larger multicenter studies.