• Nicholas Schmoke, Eunice Clark, Christopher Nemeh, Vargas ChavesDianaDDivision of Neonatology and Perinatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY., Lisa Saiman, Eva W Cheung, William Middlesworth, and Anita I Sen.
• Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
• Pediatr Crit Care Me. 2025 Feb 7.

ObjectiveDiagnosing bloodstream infections (BSIs) in patients on extracorporeal membrane oxygenation (ECMO) can be challenging due to circuit-controlled temperature, altered hemodynamics, and questionable reliability of inflammatory markers in critically ill patients. As a result, practice variability exists among ECMO centers regarding routine blood cultures for surveillance of BSI. Our study aimed to evaluate daily surveillance blood cultures in pediatric and neonatal ECMO patients.DesignRetrospective review of daily surveillance blood cultures from January 2021 to July 2023. We evaluated signs, symptoms, and laboratory results in patients with positive blood cultures.SettingAcademic children's hospital, New York, NY.PatientsAll pediatric and neonatal patients supported on ECMO.InterventionsNone.Measurements And Main ResultsWe identified a cohort of 111 patients (39 neonates and 72 children) who were supported with ECMO. Daily blood cultures were obtained on 1059 (99%) of 1065 completed ECMO days. Overall, 3% (35/1059) of blood cultures were positive, affecting 6% (7/111) of patients. All seven patients had new evidence of infection on the day of their first positive blood culture; six had clinical signs of infection, including new-onset hypotension, hypothermia, or respiratory decline, and the remaining patients had newly elevated inflammatory markers.ConclusionsDaily surveillance blood cultures are low-yield in our practice with pediatric and neonatal ECMO patients. Our experience shows that changes in clinical status, including abnormal physical or laboratory findings consistent with infection, are associated with BSI, allowing for timely diagnosis. These criteria should prompt as-needed blood cultures, reducing blood draws and preventing costly and unnecessary daily surveillance cultures.Copyright © 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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