Limiting collateral damage: Nosocomial infections in patients with temporary mechanical circulatory support

The use of temporary mechanical circulatory support (tMCS) and extracorporeal membrane oxygenation (ECMO) for patients with cardiopulmonary compromise is on the rise. While these tMCS systems provide life-saving interventions, they also pose a significant risk of nosocomial infections, which are associated with higher mortality rates. Patients receiving tMCS are critically ill and require intensive care, increasing their vulnerability to infections. Common nosocomial infections include bloodstream infections (BSI) and ventilator-associated pneumonia (VAP) in patients with ECMO and wound-related complications in patients with microaxial temporary ventricular assist devices (tVADs). Key preventative measures include the incorporation of sound ICU practices such as chlorhexidine washes, minimizing disconnections, instituting VAP bundles, and promoting enteral nutrition. The practice of continuing prophylactic antibiotics while patients are on ECMO is not routinely recommended. While treatment strategies hinge primarily on antibiotics, ensuring adequate therapeutic levels of antibiotics is challenging and may contribute to suboptimal response to systemic antibiotics in these patients. A strategy of early liberation of patients from ECMO and conversion to temporary ventricular support (temporary LVAD, RVAD, or both) may promote early extubation and patient mobilization. Whether this strategy independently reduces infectious complications remains unknown. This review examines the epidemiology and etiology of nosocomial infections in patients receiving tMCS, summarizes current prevention and treatment strategies, and discusses the impact of infection on clinical outcomes.