Occurrence of Delirium during ECMO Therapy in a Critical Care Unit in Poland—A Cross-Sectional Pilot Study

Abstract

Background: The problem of delirium during extracorporeal membrane oxygenation (ECMO) therapy, which has rarely been studied, is an important issue since it is necessary to ensure patient safety during therapy. This study aimed to show the incidence of delirium in patients after extracorporeal membrane oxygenation therapy and factors affecting the occurrence of delirium in this group of patients. Design: A cross-sectional study was conducted. Method: The study involved a group of patients from an intensive cardiac care unit who received extracorporeal membrane oxygenation therapy. The study lasted for more than two years, in the period from 2018 until 2020. The Nursing Delirium Screening Scale (NuDESC) and the Delirium Observation Screening Scale (DOSS) were applied. Additionally, the patients were examined using Numeric Rating Scale (NRS), the Insomnia Severity Index (ISI), the Richmond Agitation Sedation Scale (RASS), the Ramsay Sedation Scale (RSS), and a thirst intensity scale; ultimately, relationships between these factors and delirium were examined. Results: In patients who underwent ExtraCorporeal Membrane Oxygenation (ECMO) therapy, delirium was confirmed by the NuDESC in 68.75% of patients in the evening hours, while it was measured by the DOSS scale in 84.38% of patients in the morning. The study found that ECMO delirium was not associated with hyperactivity, sleep disturbance, sedation, pain, or thirst. Conclusion: Delirium in patients undergoing ECMO therapy was confirmed by both the NuDESC and DOSS. Factors such as thirst and sleep disturbance after ECMO therapy were shown to influence the occurrence of delirium. The diagnosis of delirium using standardized scales is possible provided that more tests are carried out. Research should be conducted to determine whether the NuDESC is equivalent to the DOSS.

Delirium and Long-Term Outcomes among Survivors of Extracorporeal Membrane Oxygenation Therapy: A Nationwide Cohort Study in South Korea

“…24 Therefore, the method of screening and measuring delirium among ECMO patients in their study is different from our study, and careful interpretation is needed to understand our current findings and the results of Krupa et al's study. 24 In this study, we observed that older age, male sex, longer duration of ICU stay, and underlying depression were associated with a higher incidence of delirium among South Korean ECMO survivors. This is in keeping with a report where older age and length of hospital and ICU stay were shown to be risk factors for the development of delirium among critically ill patients, 25 and another where male sex and underlying depression were shown to be risk factors for the development of delirium among elderly and hospitalized patients.…”

“…24 Therefore, the method of screening and measuring delirium among ECMO patients in their study is different from our study, and careful interpretation is needed to understand our current findings and the results of Krupa et al's study. 24…”

“…A recent cohort study by Krupa et al in Poland, using surveys, reported that delirium symptom was observed in the 68.75% of ECMO patients in the evening hours. 24 The prevalence of the delirium in the study by Krupa et al is much higher than that in our study. First, Krupa et al included only 32 ECMO patients, then they used Nursing Delirium Screening Scale and Delirium Observation Screening Scale to examine prevalence of delirium as a cross-sectional pilot study.…”

“…First, Krupa et al included only 32 ECMO patients, then they used Nursing Delirium Screening Scale and Delirium Observation Screening Scale to examine prevalence of delirium as a cross-sectional pilot study. 24 Therefore, the method of screening and measuring delirium among ECMO patients in their study is different from our study, and careful interpretation is needed to understand our current findings and the results of Krupa et al's study. 24 In this study, we observed that older age, male sex, longer duration of ICU stay, and underlying depression were associated with a higher incidence of delirium among South Korean ECMO survivors.…”

Characteristics of Delirium and Its Association with Sedation and In-Hospital Mortality in COVID-19 Patients on Veno-venous Extracorporeal Membrane Oxygenation

“…Delirium, characterized by acute and uctuating alterations in consciousness, often precipitated by underlying medical illness 1 , is the most common neurological complication observed in intensive care units (ICUs), with a reported prevalence of up to 82% in mechanically ventilated patients 2 . Delirium prevalence has been studied in critically ill patients, including those with post-operative complications 3 , general ICU needs 2,4,5 , acute respiratory distress syndrome 6 (ARDS), extracorporeal membrane oxygenation (ECMO) 7 support, intracerebral hemorrhage 8 , status epilepticus 9 , and acute heart failure 10 . In many of these studies 2,4,8,10 , delirium portended worsened patient survival.…”