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To the Editor, In a recent review published in Intensive Care Medicine, Abrams et al. listed the research agenda of extracorporeal membrane oxygenation (ECMO)-associated infections. One of the questions was “how should cannula-associated infection be defined?” [1]. Literature on ECMO cannula-associated infections is very scarce [2, 3], and no clear definition is available. Then, diagnostic workup of cannula-related infections is currently derived from central catheter-related infection guidelines. For catheter-related infection, a positive catheter tip culture is a diagnostic criterion [4]. However, this attitude cannot be fully transposed to ECMO cannula-related infections, as cannula cannot be easily removed and changed for tip culture. We therefore aimed at evaluating the performance of cannula swab and subcutaneous needle aspirate for predicting the results of the cannula’s tip culture. In this prospective observational pilot study, patients treated by ECMO at the Besancon University Hospital (France) were enrolled. When patients had sepsis or local signs of cannula-associated infection, cannula swab and subcutaneous needle aspirate (Fig. 1d) of both arterial and venous cannulas were systematically obtained for culture. For subcutaneous needle aspirate, after cleaning with an antiseptic solution, a catheter for peripheral venous access was inserted on 1 to 3 cm along the ECMO cannula. If no exudate was aspirated, 1 mL of saline was injected and re-aspirated. The aspirate was sent for bacterial culture. Quantitative culture was not performed, and all positive cultures were considered. At the time of ECMO weaning, the cannula tips were also collected for culture. Culture of cannula swab and subcutaneous needle aspirate were considered as “positive AND fully correspondent” with the cannula tip if it detected all the pathogens of the cannula tip. Culture of cannula swab and subcutaneous needle aspirate were considered as “positive AND not fully correspondent” if the culture was positive but some pathogens were lacking or were different.

ECMO cannula-associated infections: interest of cannula swab and subcutaneous needle aspirate samples for prediction of cannula tip culture