ID:122 FC-D03-10 Surveillance vs On-demand Blood Culture: Management of Paediatric ECMO

Background/Objectives: Routine surveillance blood cultures are commonly obtained in paediatric extracorporeal membrane oxygenation (ECMO); however, their clinical utility remains uncertain, and they are not recommended by current guidelines. At our institution, surveillance blood cultures were obtained every 24 hours, in addition to on-demand cultures when infection was suspected. We evaluated the diagnostic yield and potential clinical impact of routine surveillance blood cultures during paediatric ECMO. Methods: We conducted a retrospective cohort study of paediatric ECMO in our ICU between January 2018 and December 2025. Positive blood cultures were categorized as either surveillance (S) cultures (obtained routinely) or on-demand (O) cultures (obtained due to suspected infection). Results: Seventy-six patients were included (median age 7 months; median weight 5.9 kg). Baseline characteristics and outcomes for the overall cohort and by culture group (S vs O) are summarized in the table. Among the S group, two cases remained asymptomatic, and in two cases, culture positivity preceded the onset of clinical symptoms, which prompted earlier initiation or modification of antimicrobial therapy. Conclusions: Routine surveillance blood cultures during paediatric ECMO may facilitate earlier detection of bacteremia and support timely optimization of antimicrobial therapy, particularly in younger and lower-weight patients. In younger and lower-weight patients on ECMO, signs of infection are often difficult to detect, suggesting the importance of surveillance blood cultures.