Prevention and management of nosocomial infections in patients undergoing extracorporeal membrane oxygenation: a summary of best evidence
Abstract
Purpose
This study aimed to systematically search, evaluate, and synthesize the latest evidence on the prevention and management of nosocomial infections in patients supported by extracorporeal membrane oxygenation.
Methods
The study included clinical practice guidelines, expert consensus statements, systematic reviews, and other relevant publications. The quality of the included literature was rigorously assessed using appropriate tools such as AGREE II and AMSTAR. Data extraction and evidence synthesis were performed independently by two researchers. A comprehensive search was conducted across multiple databases and sources, including PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Data, VIP, SinoMed, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Extracorporeal Life Support Organization website, and UpToDate. The search covered the period from the inception of each database up to October 31, 2025.
Results
Fourteen studies met the inclusion criteria, comprising 2 clinical decisions, 4 guidelines, 4 expert consensus documents, 2 systematic reviews, and 2 cohort studies. All 14 studies were included following quality assessment. A total of 27 evidence items were synthesized and categorized into three domains: (1) infection prevention during extracorporeal membrane oxygenation initiation, (2) infection prevention during extracorporeal membrane oxygenation run, and (3) monitoring and treatment of extracorporeal membrane oxygenation-related infections.
Conclusion
The prevention and control of nosocomial infections in patients receiving extracorporeal membrane oxygenation requires a comprehensive, bundle-based management strategy grounded in the best available evidence. The evidence synthesized in this study is both robust and practical. We recommend that clinical institutions adapt these evidence-based recommendations into specific clinical protocols and checklists tailored to their local context, with the ultimate goal of effectively reducing infection rates and improving clinical outcomes in patients receiving extracorporeal membrane oxygenation.