ECMO antibiotics

Indication	Prophylaxis	Timing	Duration
ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if not on anitbiotics with both gramnegative and grampositive cover already	Cephazolin 50mg/kg up to 1g IV or (if cephazolin unavailable)Cephalothin 50mg/kg up to 2g IV	Optimal timing for Beta-Lactams: administer 30 – 60min before incision	2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly, remember to cease after 24hrs
Known MRSA infection or colonization, currently or in the past	Cephazolin 50mg/kg up to 1g IV plusVancomycin 25mg/kg up to 1.5g (child < 12yrs: 30mg/kg up to 1.5g)	Optimal timing for Beta-Lactams: administer 30 – 60min before incision; for Vancomycin: slow infusion, starting 60min before, and finishing immediately before incision, CVL not required	2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly, remember to cease after 24hrs; no further doses of Vancomycin required
Penicillin / Cephalosporin allergy	Vancomycin 25mg/kg up to 1.5g (child < 12yrs: 30mg/kg up to 1.5g) IV plusGentamicin 2mg/kg IV	Optimal timing for Beta-Lactams: administer 30 – 60min before incision; for Vancomycin: slow infusion, starting 60min before, and finishing immediately before incision, CVL not required	No further doses required
ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if on anitbiotics with both gramnegative and grampositive cover already	No further prophylaxis required	n/a	n/a

---

References:

[1] Therapeutic Guidelines: Antibiotic, 2006: Therapeutic Guidelines Ltd, Melbourne.

[2] Ann Thorac Surg 2006, 81:397-404: The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part 1: Duration.

[3] The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part 2: Antibiotic Choice. Ann Thorac Surg 2007;83:1596-76.

---

All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or Android. A list of contributors can be seen here.