We read with interest the recently-published article by Winiszewski et al.¹ detailing the prevalence and risk factors associated with extracorporeal membrane oxygenation (ECMO) cannulae-related infections (CRIs). Winiszewski highlights a number of pertinent issues related to cannulae infections which, we believe, require further investigation to reduce CRI and improve our patients’ outcomes.

It is of interest that the definitions of CRI Winiszewski used were of the author’s own derivation – primarily because there are currently no standardized definitions of CRI to guide diagnosis in clinical practice. This concurs with previous articles that use variable, nonstandardized or ECMO-specific, infection definitions,^2,3 reporting CRI prevalence of between 1.1% and 24%.^1–7 Factors such as the inability to routinely culture and replace cannulae,^5,6 artificial temperature regulation,^5,8 and the systemic inflammatory response to the extracorporeal circuit⁹ mean that general nosocomial infection surveillance definitions^10,11 and central-line associated bloodstream infection guidelines,^12,13 are not appropriate in this population. Urgent consensus is required to develop ECMO-specific infection definitions, not only for CRI but all nosocomial infections on ECMO, to efficiently and reliably diagnose infectious complications, quantify the clinical issue, and improve patient care.