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Introduction
The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia.
Methods
A retrospective observational study with prospective health related quality of life (HRQoL) assessment was c...
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Objectives:
Although there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorp...
Background: While there is substantial published experience of ECMO during the H1N1 pandemic, less is known about the use of ECMO in patients with seasonal influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation (ECMO) would differ for those with seasonal influenza...
Background
Extracorporeal membrane oxygenation (ECMO) is a cutting-edge life-support treatment measure for patients with severe cardiac and pulmonary illnesses. Although there are several systematic reviews (SRs) about ECMO, it remains to be seen how quality they are and how efficacy and safe the information about ECMO they describe is in these SRs...
On April, 2009, pandemic influenza (H1N1 2009) emerged in the United States at first. Clinical outcomes of this infection are reported as ranging from self-limited illness to respiratory failure or death. There were more than 250 deaths due to pandemic influenza until March 2010. Influenza-related deaths occurred in the elderly and in patients with...
Citations
... Some patients who survive ECMO can improve their quality of life and return to work within a year, 1 although in a cohort of ECMO survivors with acute respiratory distress syndrome (ARDS), only a few (26%) returned to their previous level of work. 2 The COVID-19 pandemic has posed a significant challenge to critical care settings, and healthcare systems worldwide have struggled to make intensive care accessible to the overwhelming number of patients. However, studies have shown that early mobilization can help patients transition from intensive care to step-down units, making critical care resources available for other patients. ...
Background and purpose
Current information on the latest rehabilitative practices is limited, with previous reviews only covering data up to October 2021, and some considering only patients on awake ECMO or with COVID-19. This review aims to present a concise overview of the latest findings on rehabilitation and highlight emerging trends for patients undergoing ECMO support.
Methods
This integrative review was conducted by searching the National Library of Medicine – PubMed database. Two different search strings “extracorporeal membrane oxygenation” AND “rehabilitation” and “extracorporeal membrane oxygenation” AND “physiotherapy” were used to search the published literature. Articles that did not describe rehabilitation techniques, editorials, conference proceedings, letters to editor, reviews and research protocols were excluded. Studies conducted on pediatric populations were also excluded. The search process was completed in December 2023.
Results
Thirteen articles were included in the final analysis. Eight hundred and thirty-nine patients aged between 27 and 63 years were included; 428 were men (51%). In 31% of the included studies, patients had COVID-19; nevertheless, rehabilitative activities did not differ from non-COVID-19 patients. In most studies, rehabilitation commenced within the first 48–96 h and consisted of progressive exercise and out-of-bed activities such as sitting, standing and walking.
Conclusion
Current practice focuses on rehabilitative protocols that incorporate exercise routines with progressive intensity, greater emphasis on out-of-bed activities, and a multidisciplinary approach to patient mobilization.
... Seven studies (n = 194) reported proportions of neurocognitive impairment. 19,21,27,29,[45][46][47] The prevalence of neurocognitive impairment (memory, attention, or reasoning issues) at long-term follow-up was 38% (95% CI 13%-65%, Figure 3). ...
Abstract
Background and Objectives
Despite the common occurrence of neurologic complications during extracorporeal membrane oxygenation (ECMO) support, data on long-term neuropsychiatric, neurocognitive, and functional outcomes are sparse. We aimed to determine the prevalence of long-term neuropsychiatric symptoms, neurocognitive and functional impairment, and favorable neurologic outcomes in adult patients who receive ECMO.
Methods
PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for text related to ECMO and neuropsychiatric, neurocognitive, and functional outcomes from inception to May 3, 2023. Our primary outcome was the prevalence of neuropsychiatric symptoms (pain/discomfort, anxiety, depression, posttraumatic stress disorder [PTSD], and sleep disturbance) at long-term (≥6 months) follow-up. Our secondary outcomes were the prevalence of neurocognitive impairment (memory, attention, and reasoning), functional impairment (daily activities, physical activity/mobility, and personal/self-care), and favorable neurologic outcomes (Cerebral Performance Category ≤2, modified Rankin scale ≤3, or Glasgow Outcome Scale ≥4). This study was registered in PROSPERO (CRD42023420565).
Results
We included 59 studies with 3,280 patients (median age 54 years, 69% male). The cohort consisted of 86% venoarterial (VA)–ECMO (n = 2,819) and 14% venovenous (VV)–ECMO (n = 461) patients. More than 10 tools were used to assess neuropsychiatric and neurocognitive outcomes, indicating a lack of standardization in assessment methodologies. The overall prevalence of neuropsychiatric symptoms was 41% (95% CI 33%–49%): pain/discomfort (52%, 95% CI 42%–63%), sleep disturbance (37%, 95% CI 0%–98%), anxiety (36%, 95% CI 27%–46%), depression (31%, 95% CI 22%–40%), and PTSD (18%, 95% CI 9%–29%). The prevalence of neurocognitive impairment was 38% (95% CI 13%–65%). The prevalence of functional impairment was 52% (95% CI 40%–64%): daily activities (54%, 95% CI 41%–66%), mobility (41%, 95% CI 28%–54%), and self-care (21%, 95% CI 13%–31%). The prevalence of neuropsychiatric symptoms in VV-ECMO patients was higher than that in VA-ECMO patients (55% [95% CI 34%–75%] vs 32% [95% CI 23%–41%], p = 0.01), though the prevalence of neurocognitive and functional impairment was not different between the groups. The prevalence of favorable neurologic outcomes was not different at various follow-ups: 3 months (23%, 95% CI 12%–36%), 6 months (25%, 95% CI 16%–35%), and ≥1 year (28%, 95% CI 21%–36%, p = 0.68).
Discussion
A substantial proportion of ECMO patients seemed to experience neuropsychiatric symptoms and neurocognitive and functional impairments at long-term follow-up. Considerable heterogeneity in methodology for gauging these outcomes exists, warranting the need for standardization. Multicenter prospective observational studies are indicated to further investigate risk factors for these outcomes in ECMO-supported patients.
... 11 These neurological complications of the lower extremity represent severe limitations in daily life and thus a significant burden for the caregivers, the patients, and the health infrastructure. 12 Aim of this systematic review was to investigate the prevalence of neurological complications in the lower extremity ipsilateral to the femoral cannulation in adults after ECMO and to describe possible underlying mechanisms. ...
Background
Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development.
Objective
Aim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to describe possible underlying mechanisms.
Method
A systematic literature search was performed in Medline-Ovid, Embase, Cochrane Library, CINAHL, and PEDro until April 2021 for clinical trials in English or German language which quantified neurologic complications in the lower extremity ipsilateral to the ECMO cannulation of adults. The complications had to be delimitable to intensive care unit–acquired weakness. Methodological quality was assessed by 2 independent investigators using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute.
Results
Eight observational studies were included in the synthesis. Study quality was good to fair in 88% of the papers. Overall, 47 of 202 patients (23.3%; ranging from 3% to 48% across studies) with femoral ECMO cannulation showed neurologic complications of the lower extremity ipsilateral to the cannulation. Peripheral ischemia and compression of nerves by the ECMO cannula are discussed as mechanisms of injury.
Conclusion
The occurrence of neurological complications after ECMO was common and can lead to long-term impairment. The mechanisms are largely unknown but currently there is no sufficient evidence for the involvement of ECMO. Standardized assessments are needed to systematically screen for neurological complications early after ECMO, to enable countermeasures and prevent further complications.
... The most frequently used tools were the SF-36 45 (n ¼ 21) and the EuroQol (EQ), 46 either as the 3or 5-level version, or its visual analogue scale (n ¼ 19). 46 Fifteen studies focussed solely on exploring HRQoL, 3 in general/mixed cohorts, 47e49 4 in patients with sepsis, 27e30 and 8 in special patient cohorts such as those treated with extracorporeal membrane oxygenation, 33 high-risk cardiac surgical patients, 26 H1N1 influenza, 35 patients with comorbidities, 50 patients who received renal replacement therapy, 42 a delirium bundle, 16 and in a study of early mobilisation in the ICU. 51 One study reported the association between critical illness and 1-year incidence of orthopaedic complications and fracture risk. ...
Introduction:
Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised.
Objective:
The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia.
Inclusion criteria:
Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness.
Methods:
The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022.
Results:
There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved.
Conclusions:
Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
... The same can be said of anxiety (50% and 56%) and depression (28% and 28%) as well as a risk for post-traumatic stress disorder (41% and 44%, respectively). More than half of the survivors returned to work; this finding is also consistent with other studies reporting similar findings about anxiety or PTSD [29][30][31]. ...
Although extracorporeal life support is an expensive method with serious risks of complications, it is nowadays a well-established and generally accepted method of organ support. In patients with severe respiratory failure, when conventional mechanical ventilation cannot ensure adequate blood gas exchange, veno-venous extracorporeal membrane oxygenation (ECMO) is the method of choice. An improvement in oxygenation or normalization of acid–base balance by itself does not necessarily mean an improvement in the outcome but allows us to prevent potential negative effects of mechanical ventilation, which can be considered a crucial part of complex care leading potentially to an improvement in the outcome. The disconnection from ECMO or discharge from the intensive care unit should not be viewed as the main goal, and the long-term outcome of the ECMO-surviving patients should also be considered. Approximately three-quarters of patients survive the veno-venous ECMO, but various (both physical and psychological) health problems may persist. Despite these, a large proportion of these patients are eventually able to return to everyday life with relatively little limitation of respiratory function. In this review, we summarize the available knowledge on long-term mortality and quality of life of ECMO patients with respiratory failure.
... . Physical, mental and psychological outcome at 3, 6 and 12 months from discharge. Mini Nutritional Assessment Score, median (IQR) 11 (9)(10)(11)(12) 14 (13)(14) 14 ( b) P value refers to a mixed effect model for the difference between BMI gain (i.e the difference between actual BMI and baseline BMI) from 3 to 12 months. In post-hoc analysis median BMI variation was significant at 6 months in comparison to 3 months (p = 0.037). ...
... c) In post-hoc analysis median MNA at 12 months (p < 0.001) and at 6 months (p = 0.001) was significantly higher in comparison to 3 months. Rajajee et al. [4] Holzgraefe et al [5] Sylvestre et al [6] Schmidt et al [7] Luyt et al [8] Sanfilipp o et al [9] Hodgso n et al [10] Mirabel et al [11] Muller et al [12] Corsi et al [13] Risnes et al [14] Tramm et al [15] Chen et al [16] 46 -42 ---36 45 -42 --50 --45 49 HRQoL mental component 53 -51 --45 50 -52 36 -50 --50 58 Ventilatory Assistance (%) ...
Extracorporeal membrane oxygenation (ECMO) has been used in highly selected COVID-19 patients with severe respiratory failure. Scarce data exist on long-term outcomes of these patients. We performed a single-center prospective evaluation of consecutive COVID-19 ECMO patients successfully discharged from the intensive care unit between February 2020 and January 2022. Physical, cognitive and psychological outcome was assessed at 3, 6, and 12 months by in-person evaluation. All the 34 discharged patients (median age 49 years old) were alive at one year, and 25 of them were evaluated at the follow-up clinic. 67% of patients had muscle weakness, with improvement over time (p = 0.032). The percentage of patients able to return to work progressively increased, up to 86% at 1 year. 23% of patients experienced fatigue. Participation restriction improved over time for both physical (p = 0.050) and emotional (p = 0.005) problems. Cognitive impairment, anxiety, and depression occurred in 29%, 29%, and 23% of patients, respectively, with no changes over time. Health-related quality of life was good. In conclusion, COVID-19 ECMO patients suffer from significant long-term sequelae. However, multidimensional outcomes continued to improve over the follow-up time.
... Our results on HRQOL support the findings of a recent literature review of QOL in ECMO treatment in adults, revealing higher scores in VV ECMO patients compared with VA ECMO [22]. For respiratory patients, our results are comparable to several smaller cohort studies [4,[23][24][25]. In a study from Germany in patients requiring ECMO to support cardiogenic shock, the EQ-5D indices of patients with and without cardiac surgery during the index admission were similar to our results although the QOL was significantly lower than the normative age-matched population in Germany [25]. ...
Purpose: This study reports on survival and health related quality of life (HRQOL) after extracorporeal membrane oxygenation (ECMO) treatment and the associated costs in the first year.
Materials and Methods: Prospective observational cohort study patients receiving ECMO in the intensive care unit during August 2017 and July 2019. We analyzed all healthcare costs in the first year after index admission. Follow-up included a HRQOL analysis using the EQ-5D-5L at 6 and 12 months.
Results: The study enrolled 428 patients with an ECMO run during their critical care admission. The one-year mortality was 50%. Follow up was available for 124 patients at 12 months. Survivors reported a favorable mean HRQOL (utility) of 0.71 (scale 0–1) at 12 months of 0.77. The overall health status (VAS, scale 0–100) was reported as 73.6 at 12 months. Mean total costs during the first year were $204,513 ± 211,590 with hospital costs as the major factor contributing to the total costs. Follow up costs were $53,752 ± 65,051 and costs of absenteeism were $7317 ± 17,036.
Conclusions: At one year after hospital admission requiring ECMO the health-related quality of life is favorable with substantial costs but considering the survival might be acceptable. However, our results are limited by loss of follow up. So it may be possible that only the best-recovered patients returned their questionnaires. This potential bias might lead to higher costs and worse HRQOL in a real-life scenario.
... Extracorporeal membrane oxygenation (ECMO) is increasingly used as a salvage support modality in patients with refractory cardiogenic shock and/or severe respiratory failure. Despite its widespread application [1,2], ECMO remains associated with high complication rates [3], and a considerable number of patients eventually die [4], or experience negative long-term sequelae [5,6]. The increased use of ECMO for a broadened range of indications poses a significant socio-economic burden [7,8] as its management requires extensive critical care by highly qualified personnel. ...
Purpose:
To provide an overview and evaluate the performance of mortality prediction models for patients requiring extracorporeal membrane oxygenation (ECMO) support for refractory cardiocirculatory or respiratory failure.
Methods:
A systematic literature search was undertaken to identify studies developing and/or validating multivariable prediction models for all-cause mortality in adults requiring or receiving veno-arterial (V-A) or veno-venous (V-V) ECMO. Estimates of model performance (observed versus expected (O:E) ratio and c-statistic) were summarized using random effects models and sources of heterogeneity were explored by means of meta-regression. Risk of bias was assessed using the Prediction model Risk Of BiAS Tool (PROBAST).
Results:
Among 4905 articles screened, 96 studies described a total of 58 models and 225 external validations. Out of all 58 models which were specifically developed for ECMO patients, 14 (24%) were ever externally validated. Discriminatory ability of frequently validated models developed for ECMO patients (i.e., SAVE and RESP score) was moderate on average (pooled c-statistics between 0.66 and 0.70), and comparable to general intensive care population-based models (pooled c-statistics varying between 0.66 and 0.69 for the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score). Nearly all models tended to underestimate mortality with a pooled O:E > 1. There was a wide variability in reported performance measures of external validations, reflecting a large between-study heterogeneity. Only 1 of the 58 models met the generally accepted Prediction model Risk Of BiAS Tool criteria of good quality. Importantly, all predicted outcomes were conditional on the fact that ECMO support had already been initiated, thereby reducing their applicability for patient selection in clinical practice.
Conclusions:
A large number of mortality prediction models have been developed for ECMO patients, yet only a minority has been externally validated. Furthermore, we observed only moderate predictive performance, large heterogeneity between-study populations and model performance, and poor methodological quality overall. Most importantly, current models are unsuitable to provide decision support for selecting individuals in whom initiation of ECMO would be most beneficial, as all models were developed in ECMO patients only and the decision to start ECMO had, therefore, already been made.
... SF-36 derives a total score from eight di erent domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and -mental health. e score in each domain ranges from 0 to 100, 100 representing the best score with a ve-point difference considered to be clinically signi cant in adequacy with previous intensive care studies (10)(11)(12). Patients were compared between BICAR-ICU groups and, as a secondary endpoint, with the French general ...
... We observed a slight reduction of HRQoL in physical domains, with the lowest scores in the energy/ fatigue domains, physical functioning, and role limitations due to physical health domains of the SF-36. We reported the same results with a more marked physical decrease in physical domains than in psychologic and social domains in studies focusing on ARDS (10,21), sepsis (8,11,23), and trauma (19,20). e reasons why the patients in the present cohort had lower physical scores than in the general population remain unclear. ...
Objectives:
Long-term prognosis of ICU survivors is a major issue. Severe acidemia upon ICU admission is associated with very high short-term mortality. Since the long-term prognosis of these patients is unknown, we aimed to determine the long-term health-related quality of life and survival of these patients.
Design:
Post hoc analysis of a multicenter, randomized, controlled trial.
Setting:
Twenty-six French ICUs.
Patients:
Day 28 critically ill survivors admitted with severe acidemia and enrolled in the BICAR-ICU trial.
Intervention:
Sodium bicarbonate versus no sodium bicarbonate infusion according to the randomization group.
Measurements and main results:
The primary outcome was health-related quality of life (HRQoL) measured with the 36-item Short Form Health Survey and the EuroQol 5-D questionnaires. Secondary outcomes were mortality, end-stage renal disease treated with renal replacement therapy or renal transplantation, place of residence, professional status, and ICU readmission. HRQoL was reduced with no significant difference between the two groups. HRQoL was reduced particularly in the role-physical health domain (64/100 ± 41 in the control group and 49/100 ± 43 in the bicarbonate group, p = 0.28), but it was conserved in the emotional domains (96/100 ± 19 in the control group and 86/100 ± 34 in the bicarbonate group, p = 0.44). Forty percent of the survivors described moderate to severe problems walking, and half of the survivors described moderate to severe problems dealing with usual activities. Moderate to severe anxiety or depression symptoms were present in one third of the survivors. Compared with the French general population, HRQoL was decreased in the survivors mostly in the physical domains. The 5-year overall survival rate was 30% with no significant difference between groups.
Conclusions:
Long-term HRQoL was decreased in both the control and the sodium bicarbonate groups of the BICAR-ICU trial and was lower than the general population, especially in the physical domains.
... EQ-VAS represents a more personal perception of health, whereas index values are used to represent socially perceived health status. EQ-VAS, which has been reported in other published series, was quite similar to ours [38]. A higher dispersion is observed on EQ-VAS, especially in the RCA group. ...
Background:
The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for hemodynamic support is on the rise. Not much is known about the impact of extracorporeal membrane oxygenation (ECMO) and its complications on long-term survival and quality of life.
Methods:
In this single-center, cross-sectional study, we evaluated the survival and quality of life in patients treated with VA ECMO between May 2009 and July 2019. Follow-up was conducted between November 2019 and January 2020.
Results:
Overall, 118 patients were evaluated in this study. Of the 37 patients who were alive at hospital discharge, 32 answered the EuroQol-5 dimensional-5-level questionnaire (EQ-5D-5L). For patients discharged alive from the hospital, mean survival was 8.1 years, 8.4 years for cardiogenic shock, and 5.0 years for patients with refractory cardiac arrest. EQ-5D-5L index value of ECMO survivors was not significantly different from the general age-matched population. Neurologic complications and major bleeding during index hospitalization limit long-term quality of life.
Conclusions:
Patients treated with VA ECMO have high in-hospital mortality, with extracorporeal membrane oxygenation cardio-pulmonary resuscitation patients being at higher risk of early death. However, once discharged from the hospital, most patients remain alive with a reasonable quality of life.
