Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

Abstract

Aims The aims of this study were to evaluate health‐related quality of life (HRQL) among patients treated with extracorporeal membrane oxygenation (ECMO) in northern Norway over a period of 27 years (1988–2015) and to identify variables related to HRQL. Methods and results A retrospective inquiry of the ECMO registry at the University Hospital of North Norway identified 74 ECMO‐treated patients (mean age 49 years, 65% males). Acute cardiac failure was the dominant indication (58%), and venoarterial ECMO was the dominant mode of treatment (87%). Mortality for discharged patients was recorded on 20 September 2016. Thirty (41%) survivors were identified. Twenty‐three survivors were eligible for the survey and received a set of questionnaires at home. The main outcome measure was HRQL as measured with the 36‐item Short‐Form health survey (SF‐36) (RAND Short Form‐36 v1.2). Other questionnaires covered demographic information, problems with functioning in usual daily activities (such as hobbies, household chores, family, or work), employment status, and psychological distress. The survey was completed by 20 (87%) survivors (mean age = 49 years, 12 men). Indications for ECMO treatment (VA = 90%) had been respiratory failure (25%), cardiac failure (60%), and extracorporeal cardiopulmonary resuscitation (15%). The average time since ECMO treatment was 6.5 years. Seventy‐five percent reported mental HRQL (SF‐36 Mental Component Summary, mean = 43, SD = 5) or physical HRQL (SF‐36 Physical Component Summary, mean = 43, SD = 4.5) within the normal range (T = 50 ± 10) in comparison with age‐matched population data from national norms. Half of the responders reported problems on the SF‐36 subscales general health and role physical. Seventy percent reported problems on the SF‐36 subscale role emotional. All but one responder lived independently without any organized care, and 90% reported no problems related to basic self‐care. Half of those in working age had returned to work after ECMO treatment. Forty percent of the responders reported some degree of restrictions in usual daily activities, problems with mobility (35%), anxiety/depression (35%), or pain/discomfort (55%). Significant univariate associations were observed for poorer HRQL and higher reports of psychological distress, pain, and experiencing restrictions in usual everyday activities. Improved HRQL was significantly related to an extended time since ECMO treatment. Conclusions Our survey indicates an overall positive long‐term HRQL outcome for our ECMO survivors. A subset reported problems with functioning and HRQL. Future research should focus on identification of the survivors at risk for poor recovery who may benefit from rehabilitation interventions.

Long‐term mortality associated with depression among South Korean survivors of extracorporeal membrane oxygenation

“…Specifically, prevalence assessment might have suffered from selection bias due to nonresponse to the surveys (Rupp et al., 2002 ). Indeed, the proportions of survivors of ECMO who responded to the survey in these studies were 68.4% (13/19) (O'Brien et al., 2020 ), 76.7% (23/30) (Orbo et al., 2019 ), and 86.8% (33/38) (Sanfilippo et al., 2019 ). However, our study might have suffered from detection bias (Sjolander et al., 2008 ) because we used the registered ICD‐10 codes for depression.…”

Long-Term Follow-Up of Survivors of Extracorporeal Life Support Therapy for Cardiogenic Shock: Are They Really Survivors?

“…However, follow-up in their study was increasingly incomplete for time intervals exceeding 12 months, with survival data available for only 66% of patients at 24 months [ 14 ]. Ørbo et al evaluated heart-related quality of life after ECLS [ 15 ]. They identified 30 (41%) of 74 ECLS-survivors in Norway and surveyed 23 survivors, with 40% of respondents reporting some degree of restriction in everyday activities and depression in 35% of cases [ 15 ].…”

Do-(Not-)Mechanical-Circulatory-Support Orders: Should We Ask All Cardiac Surgery Patients for Informed Consent for Post-Cardiotomy Extracorporeal Life Circulatory Support?

“…Since PC-ECLS treatment is only utilized in critically ill patients, such a procedure will influence the psychological well-being of the patient even more. Long-time follow-up shows that significant anxiety is present in one third to half of the patients after ECLS, depression in one fourth, and that only half of the patients return to work [25][26][27][28][29][30][31]. Furthermore, survivors have high rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) [25,29,30,32].…”