Development of Review Indicators for Infection Prevention and Management in Patients on Extracorporeal Membrane Oxygenation (ECMO) and Analysis of Barriers

doi:10.12104/j.issn.1674-4748.2025.16.007

Abstract：Objective: To understand the gap between clinical practice and best evidence in infection prevention and management for patients on extracorporeal membrane oxygenation (ECMO), analyze the barriers to evidence application, and develop strategies for practice change to provide reference for clinical settings. Methods: By identifying evidence-based questions, retrieving and summarizing relevant evidence, developing review indicators for baseline review, then analyzing barriers based on the results of the baseline review and formulating strategies for practice change. A total of 45 ECMO patients, 41 ICU nurses, and 7 doctors from an ICU in a hospital in Wuhan from January to December 2021 were selected as the subjects of the review. Results: A total of 13 pieces of best evidence were included, and 13 review indicators were developed, among which 12 review indicators had an adherence rate of less than 60%. Barriers included the lack of evidence-based guidelines for infection prevention in ECMO patients; inconsistent levels of ECMO management practices across hospitals, making it difficult to refer to; heavy workload in the ICU, with nurses being busy and no implementation of a dedicated nursing model; and the absence of a unified process for infection prevention and management of ECMO patients in the department. Facilitating factors included the leadership of the nursing department's emphasis on specialized construction in the ICU and the strong learning ability and belief of medical staff. The strategy for practice change was to establish an ECMO working group, develop its work guidelines, and implement a bundle strategy for infection prevention and management in ECMO patients, integrating the assessment of ECMO infection risk factors into the nursing assessment system. Conclusion: There is a significant gap between clinical practice and evidence in infection prevention and management for ECMO patients. Clinical staff should analyze barrier factors based on the actual situation of their departments and develop reasonable intervention measures to promote evidence translation.