PC3084: Outcome of Extracorporeal Membrane Oxygenation Support Among Children with Methicillin-resistant Staphylococcal aureus Infection: A Single-center Experience

Introduction: The use of extracorporeal membrane oxygenation (ECMO) in children continues to increase nationally, including patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Survival of pediatric patients with MRSA sepsis has not improved over the last 20 years. We sought to review our institutional experience and outcomes of ECMO support among children with MRSA sepsis.

Case Description: Children aged 0-19 years who received ECMO support from October 2014 to June 2021 were reviewed retrospectively, and patients with laboratory confirmed MRSA infections were identified using ICD-9 and ICD-10 codes. In addition, demographics, diagnosis, ventilator settings, vasoactive infusions, ECMO indications and characteristics, and patient outcomes were collected. Out of 88 unique pediatric patients requiring ECMO support, 8 patients had documented MRSA infections. Three patients had a primary diagnosis of congenital cardiac defects. Only 2 patients had a prior known history of MRSA infection or colonization. Half of the patients had MRSA positive blood culture, and 7 of 8 patients had MRSA isolated from the respiratory tract. Five out of 8 patients developed sepsis during ECMO support. Five patients were initially cannulated to veno-venous (VV) - ECMO, 1 to veno-arterial (VA) -ECMO, 1 was converted from VA to VV-ECMO, and 1 was cannulated via extracorporeal cardiopulmonary resuscitation (ECPR). The duration of mechanical ventilation prior to ECMO initiation was an average of 7 days (range 0.7 to 21.8 days). The median ECMO duration was 648.1 hours (range 15.5 to 1580.5 hours). Five patients were successfully decannulated; however, only 2 patients survived to discharge. The two surviving patients were both cannulated via VV-ECMO. Mechanical ventilation prior to ECMO was 4.5 and 21.8 days in these cases with run durations of 18.9 and 29.9 days, respectively.

Discussion: Our institutional survival of patients with MRSA on ECMO is lower than what has been reported in recent database studies, but notably, 62.5% were successfully decannulated. As it has been reported in the literature, we have seen increased utilization of ECMO in patients with MRSA, with the majority of our cases occurring in the last 4 years. While both surviving patients were supported with VV-ECMO, there was no other clear trend in factors that contributed to survival.

Conclusion: MRSA continues to be a source of significant morbidity and mortality among pediatric patients, including at our own institution. On-going investigation of outcomes and factors contributing to survival in patients with MRSA infection on ECMO is warranted.