Long-term pulmonary function and quality of life in adults after extracorporeal membrane oxygenation for respiratory failure

Bahr, Viktor von; Kalzén, Håkan; Frenckner, Björn; Hultman, Jan; Frisén, K Gunilla; Lidegran, Marika; Diaz, Sandra; Malfertheiner, Maximilian; Millar, Jonathan; Dobrosavljevic, Tanja; Eksborg, Staffan; Holzgraefe, Bernhard

doi:10.1177/0267659119830244

Cited by 16 publications

(16 citation statements)

References 69 publications

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“…The respiratory group had a twofold higher odds of post-ECMO CRD development than those in the cardiovascular group. Therefore, our results suggest that pulmonary sequelae were developed in ECMO survivors without pre-ECMO CRDs after ECMO therapy due to ARDS or respiratory failure, as previously reported [ 17 , 19 ].…”

Section: Discussionsupporting

confidence: 84%

“…The findings in our study are based on the diagnostic codes registered by ICD-10 in the NHIS database, and they differed from previous studies [ 16 , 17 , 19 ], which evaluated decreased pulmonary function using diagnostic tests such as computed tomography. Our approach has both merits and disadvantages in evaluating pulmonary function among ECMO survivors.…”

Section: Discussioncontrasting

confidence: 74%

“…However, as a disadvantage, our study could not include some cases of CRDs, because some patients with CRDs might not visit outpatient clinics for various reasons such as low compliance to treatment, economic burden, and poor accessibility to medical resources. To interpret our results in the context of those presented in other studies [ 16 , 17 , 19 ], these differences in method should be considered.…”

Section: Discussionmentioning

confidence: 81%

“…In addition, in South Korea, the hospital survival rate among critically ill patients who underwent ECMO therapy due to respiratory failure has been improving in recent years [ 15 ]. Therefore, the quality of life (QOL) in ECMO survivors has emerged as an important public health issue [ 16 – 19 ]. One of the most important factors that might affect the worsening QOL in ECMO survivors is the decreased pulmonary function after discharge from the hospital.…”

Section: Introductionmentioning

confidence: 99%

“…One of the most important factors that might affect the worsening QOL in ECMO survivors is the decreased pulmonary function after discharge from the hospital. A recent retrospective cohort study reported that there was a 47% reduction in the diffusion capacity of carbon monoxide and 82% of lung parenchymal pathologic changes in 38 ECMO survivors from respiratory failure [ 19 ]. Another retrospective study reported that 21 ECMO survivors from ARDS showed lung fibrosis, and minor pulmonary function abnormalities remained common at the 365-day follow-up period [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Cho

Lee

et al. 2021

Respir Res

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Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

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Section: Discussionsupporting

confidence: 84%