Incidence of severe infections in patients undergoing extracorporeal cardiopulmonary resuscitation (E-CPR): are they comparable to patients with recovered cardiac arrest?

The use of extracorporeal cardiopulmonary resuscitation (E-CPR) has increased in recent years, yet limited data exist regarding the prevalence of infections or the systematic use of antibiotics in this highly complex patient population, compared with those admitted after recovered cardiac arrest (CA).

The objective of this study was to compare the incidence of severe infections and antibiotic use between these two populations.

We conducted a retrospective, observational study of patients admitted to our intensive care unit with refractory cardiac arrest, both from in- or out-of-hospital origin, who underwent Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) implantation between 2020 and 2025. A representative cohort of patients with recovered cardiac arrest from the same centre admitted between 2024-2025 was selected for comparison. Infections, including bloodstream infection (BSI), pneumonia and urinary tract infections, were assessed according to the criteria of the European Centre for Disease Prevention and Control (ECDC)1. Categorical variables were compared using the chi-square test and continuous variables with the Wilcoxon rank-sum test. Differences were considered statistically significant at p < 0.05.

A total of 84 patients were included: 39 E-CPR and 45 non–E-CPR. Regarding baseline characteristics, E-CPR patients were younger, had a worse prognosis at baseline and required longer mechanical ventilation, more tracheostomies and more renal replacement therapy. No deaths of infectious cause were documented (Table 1). The incidence of BSI was significantly higher in the E-CPR group compared to the non E-CPR (33% vs. 7%; p=0.002), with only 18% of cases being catheter-related. Gram-positive bacteria were the most frequently isolated microorganisms from blood cultures (Staphylococcus epidermidis and various Streptococcus spp.). The incidence of pneumonia was similar in both groups and was the most common infection among non-E-CPR patients. Regarding antibiotic therapy, both groups received early treatment, with amoxicillin-clavulanate being the most commonly used initial agent (74% in the E-CPR group and 96% in the non-E-CPR group). Daptomycin was used in 69% of E-CPR patients during the first 24 hours (Table 2). Antibiotic escalation was required in approximately half of the patients in both groups, with daptomycin being the most commonly used agent in this context.

Pneumonia remains one of the most common infections among cardiac arrest patients. However, those undergoing E-CPR exhibit a higher incidence of bacteraemia despite early use of broad-spectrum antibiotics, likely due to greater instrumentation and longer stays in the ICU. These findings highlight the importance of implementing strict nosocomial infection prevention measures within E-CPR protocols.

Baseline characteristics of the sample