Clinical Characteristics of Fever After Extracorporeal Membrane Oxygenation Decannulation: Differentiating Infectious from Non-Infectious Causes of Fever and Their Impact on Outcomes

Background: A fever is an important sign that affects patient outcomes with various etiologies in the post-decannulation period of extracorporeal membrane oxygenation (ECMO); however, the cause is not fully understood. This study aimed to investigate the characteristics and clinical implications of fevers after ECMO decannulation in critically ill patients. Methods: We conducted a retrospective, single-center study of adult patients who were successfully weaned off venoarterial (VA) or venovenous (VV) ECMO. Decannulation fever was defined as fever that occurred within 72 h of ECMO decannulation. The peak and duration of fever were followed for 2 weeks after decannulation, and the relationship with infection was assessed. Results: A total of 47 patients were included (22 [46.8%] on VA ECMO and 25 [53.2%] on VV ECMO). There were 35 (74.5%) patients who had decannulation fever, including 16 (34%) with active infections. Active infection during the study period was not related to the ECMO setting or duration; rather, infectious fever lasted longer than non-infectious fever (4 [interquartile range; IQR: 1-7] vs. 11 [IQR: 2-7] days, p = 0.023), and the C-reactive protein level was higher on post-decannulation day 7 (p = 0.006). Active infection was associated with increased mortality (odds ratio [OR] 6.067, 95% confidence interval [CI] 1.1289-32.644, p = 0.036), whereas decannulation fever was not (OR 0.156, 95% CI 0.025-0.977, p = 0.047). Conclusions: Fever is an important indicator of ECMO decannulation. However, the different timing and duration of fevers during the post-decannulation period of ECMO may have various clinical implications.