Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a rapidly expanding life-support technique worldwide. The most common indications are severe hypoxemia and/or hypercapnia, unresponsive to conventional treatments, primarily in cases of acute respiratory distress syndrome. Concerning potential contraindications, there is no mention of microbiological history, especially related to multi-drug resistant (MDR) bacteria isolated before V-V ECMO placement. Our study aims to investigate: (i) the prevalence and incidence of MDR Gram-negative (GN) bacteria in a cohort of V-V ECMOs; (ii) the risk of 1-year mortality, especially in the case of predetected MDR GN bacteria; and (iii) the impact of annual hospital V-V ECMO volume on the probability of acquiring MDR GN bacteria. All consecutive adults admitted to the Intensive Care Units of 5 Italian university-affiliated hospitals and requiring V-V ECMO were screened. Exclusion criteria were age < 18 years, pregnancy, veno-arterial or mixed ECMO-configuration, incomplete records, survival < 24 h after V-V ECMO. A standard protocol of microbiological surveillance was applied and MDR profiles were identified using in vitro susceptibility tests. Cox-proportional hazards models were applied for investigating mortality. Two hundred and seventy-nine V-V ECMO patients (72% male) were enrolled. The overall MDR GN bacteria percentage was 50%: 21% (n.59) detected before and 29% (n.80) after V-V ECMO placement. The overall 1-year mortality was 42%, with a higher risk observed in predetected patients (aHR 2.14 [1.33–3.47], p value 0.002), while not in ‘V-V ECMO-acquired MDR GN bacteria’ group (aHR 1.51 [0.94–2.42], p value 0.090), as compared to ‘non-MDR GN bacteria’ group (reference). Same findings were found considering only infections. A larger annual hospital V-V ECMO volume was associated with a lower probability of acquiring MDR GN bacteria during V-V ECMO course (aOR 0.91 [0.86–0.97], p value 0.002). 21% of MDR GN bacteria were detected before; while 29% after V-V ECMO connection. A history of MDR GN bacteria, isolated before V-V ECMO, was an independent risk factor for mortality. The annual hospital V-V ECMO volume affected the probability of acquiring MDR GN bacteria. Trial Registration ClinicalTrial.gov Registration Number NCTNCT06199141, date 12.26.2023.

中文翻译：

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回顾性分析多重耐药 Gram-nEgative bacteRia 对静脉-静脉体外膜肺氧合的分析。多中心 RANGER 研究


静脉-静脉体外膜肺氧合 （V-V ECMO） 是一种在全球范围内迅速扩展的生命支持技术。最常见的适应证是严重低氧血症和/或高碳酸血症，对常规治疗无反应，主要发生在急性呼吸窘迫综合征的情况下。关于潜在的禁忌症，没有提到微生物学史，特别是与在 V-V ECMO 放置前分离的多重耐药 （MDR） 细菌有关。我们的研究旨在调查：（i） MDR 革兰氏阴性 （GN） 细菌在 V-V ECMO 队列中的患病率和发病率;（ii） 1 年死亡风险，尤其是在预先检测到 MDR GN 细菌的情况下;（iii） 每年医院 V-V ECMO 数量对获得 MDR GN 细菌概率的影响。对 5 所意大利大学附属医院重症监护病房并需要 V-V ECMO 的所有连续住院成人进行了筛选。排除标准是年龄 < 18 岁、怀孕、静脉-动脉或混合 ECMO 配置、不完整记录、V-V ECMO 后 24 小时生存率 <。应用微生物监测的标准方案，并使用体外药敏试验确定 MDR 谱。Cox 比例风险模型用于调查死亡率。纳入了 279 例 V-V ECMO 患者 （72% 为男性）。总体 MDR GN 细菌百分比为 50%：在放置 V-V ECMO 之前检测到 21% （n.59），在放置 V-V ECMO 后检测到 29% （n.80）。总体 1 年死亡率为 42%，在预先检测到的患者中观察到更高的风险 （aHR 2.14 [1.33–3.47]，p 值 0.002），而 “V-V ECMO 获得性 MDR GN 细菌”组 （aHR 1.51 [0.94–2.42]，p 值 0.090） 则没有，与“非 MDR GN 细菌”组（参考）相比。 仅考虑感染，发现了相同的结果。在 V-V ECMO 疗程期间，医院 V-V ECMO 年量较大，获得 MDR GN 细菌的可能性较低 （aOR 0.91 [0.86–0.97]，p 值 0.002）。之前检测到 21% 的 MDR GN 细菌;而 V-V ECMO 连接后为 29%。在 V-V ECMO 之前分离出的 MDR GN 细菌病史是死亡的独立危险因素。每年医院 V-V ECMO 数量影响获得 MDR GN 细菌的可能性。试验注册 ClinicalTrial.gov 注册号 NCTNCT06199141，日期 2023 年 12 月 26 日。