Challenges of Antimicrobial Therapy in ECMO Patients

A variety of infections may lead to severe cardiorespiratory failure that necessitates extracorporeal membrane oxygenation (ECMO) support. Equally, infections acquired during ECMO remain a common cause of morbidity. The pathophysiologic mechanisms that predispose this critically unwell population to infections are poorly understood. In this setting, it is important that efforts should be directed at preventing infections and optimizing antimicrobial therapy both to treat underlying pathology and to minimize complications. There are no validated diagnostic criteria to assist with early diagnosis of infections on ECMO, which is a significant limitation. In addition, altered pharmacokinetics and pharmacodynamics during ECMO may lead to therapeutic failure or supratherapeutic concentrations, leading to potential toxicity. Inability to remove potentially infected ECMO catheters is also a major limitation. No specific infection prevention measures have been identified for ECMO-supported patients, and the role of prophylactic antibiotics remains a much-debated issue. This chapter aims to discuss the common challenges in relation to antimicrobial drug therapy on ECMO.