The epidemiology of pressure injuries in adult intensive care unit patients supported with extracorporeal membrane oxygenation

Objective: To describe the epidemiology and clinical features of pressure injury (PI) development in adult patients supported with extracorporeal membrane oxygenation (ECMO). Design: Retrospective, observational, cohort study from January 2018 to May 2023. Setting: A single-centre high-volume ECMO specialist intensive care unit (ICU). Participants: All adults (aged 18 y or more) admitted to ICU for more than 24 h. Main Outcome Measures: Any PI developing more than 24 h after ICU admission. Results: Five-hundred ICU patients were supported with ECMO during the study period. Excluding those <18 years of age and with an ICU length of stay of <24 h, 466 patients were included in the analysis. One-hundred-thirty-five (29.0%) patients acquired at least one PI during their ICU stay, with PI occurring in 80 patients (17.2%) whilst supported on ECMO. The PI incidence rate was 1.7 per 100 ECMO patient-days (confidence interval: 1.3–2.0). Patients with a PI were mechanically ventilated for longer, received more renal replacement therapy, manifested more delirium, and stayed longer in the ICU and hospital. Conversely, crude ICU and in-hospital mortality was lower in the PI group. A longer ECMO run time and a higher proportion of veno-venous ECMO was also noted in those with a PI. Factors independently associated with the acquisition of a PI were male gender, oral dietary intake, renal replacement therapy, and prolonged mechanical ventilation. The majority of the PIs acquired during ECMO were stage-two and were most commonly located on the neck and head (n = 25/96 PIs, 26.0%) and sacral region (n = 31/96 PIs, 32.3%). Only three PIs were in relation to the ECMO cannula, circuit, or dressing. Conclusion: A significant proportion of patients develop PIs while receiving ECMO. Vigilance on the prevention of medical device related PI is required. Gender, renal replacement therapy, oral diet, and length of mechanical ventilation were independent predictors for PI development in this population.