Psychiatric Outcome after Severe Cardio-Respiratory Failure Treated with Extracorporeal Membrane Oxygenation: A Case-Series

Risnes, Ivar; Heldal, Anne Taraldsen; Wagner, Kari; Boye, Birgitte; Haraldsen, Ira; Leganger, Siv; Mokleby, Kjell; Svennevig, Jan; Malt, Ulrik Fredrik

doi:10.1016/j.psym.2013.02.008

Cited by 24 publications

(18 citation statements)

References 36 publications

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“…No study specifically assessed the prevalence of anxiety symptoms at baseline prior to onset of critical illness, although one study reported a 3.5% prevalence of diagnosed anxiety disorders, such as generalized anxiety disorder (41). …”

Section: Resultsmentioning

confidence: 99%

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Nikayin

Rabiee

Hashem

et al. 2016

General Hospital Psychiatry

355

247

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Objectives To evaluate the epidemiology of, and post-intensive care unit (ICU) interventions for anxiety symptoms after critical illness Methods We searched 5 databases (1970-2015) to identify studies assessing anxiety symptoms in adult ICU survivors. Data from studies using the most common assessment instrument were meta-analyzed. Results We identified 27 studies (2,880 patients) among 27,334 citations. The Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) was the most common instrument (81% of studies). We pooled data at 2-3, 6, and 12-14 month time-points, with anxiety symptom prevalences (HADS-A≥8, 95%CI) of 32%(27-38%), 40%(33-46%), and 34%(25-42%), respectively. In a subset of studies with repeated assessments in the exact same patients, there was no significant change in anxiety score or prevalence over time. Age, gender, severity of illness, diagnosis, and length of stay were not associated with anxiety symptoms. Psychiatric symptoms during admission and memories of in-ICU delusional experiences were potential risk factors. Physical rehabilitation and ICU diaries had potential benefit. Conclusions One-third of ICU survivors experience anxiety symptoms that are persistent during their first year of recovery. Psychiatric symptoms during admission and memories of in–ICU delusional experiences were associated with post-ICU anxiety. Physical rehabilitation and ICU diaries merit further investigation as possible interventions.

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Section: Resultsmentioning

confidence: 99%

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Nikayin

Rabiee

Hashem

et al. 2016

General Hospital Psychiatry

355

247

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“…Nevertheless, ECMO survivors have comparable outcomes to those who did not need ECMO when this is assessed using the 36-item Short-Form Health Survey (SF-36) or EuroQoL questionnaire [53][54][55], although this is less than for an age-and sex-matched population. Return to work is often limited or delayed [53] and there are significant psychological sequelae [56]. Nevertheless, respiratory ECMO patients score higher on the individual domains of the SF-36 than patients on chronic renal dialysis or patients who suffer with New York Heart Association class III heart failure [57,58].…”

Section: Long-term Outcomes In Survivors Of Ecmomentioning

confidence: 99%

Extracorporeal support for patients with acute respiratory distress syndrome

Finney¹

2014

Eur Respir Rev

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Extracorporeal membrane oxygen (ECMO) has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure) study and excellent outcomes in patients who suffered severe influenza A (H1N1/09) infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1) the types of extracorporeal support available; 2) the rationale for its use; 3) the relationship with lung protective ventilation; and 4) the current evidence for its use.

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“…More emphasis is currently applied in the search for enhanced brain monitoring (14)(15)(16)(17)(18), and this includes also the elucidation of not only overt brain injury, but also the impact of ECLS on more subtle and important aspects accounting for the neurocognitive status, particularly in children (19)(20)(21).…”

mentioning

confidence: 99%

“…The actual appraisal of the importance and rate of CNS events is actually soliciting more research in this direction, hopefully enhancing further studies on alternatives for anticoagulation, more biocompatible ECLS systems and components, improved and continuous monitoring system for peripheral and central perfusion and integrity assessment, blood markers, and appropriate counteractions once a suspicion of ongoing or danger of injury may occur, and last but not least, understanding and depicting potential neuropsychological disorders (19,21).…”

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confidence: 99%

“…The application of different sedation strategy, the actual understanding if hypothermia may help to avoid or reduce severe brain damage in case of cardiac arrest or low-flow state, the conclusive proof of the effects on improper management of gas exchange on ECLS (particularly in the CO 2 reduction and management), and at last but not least, the recognition of further potential determinants of CNS integrity or injury, will certainly improve patient outcome and favor patient selection for ECLS, avoiding futile run, or improve ECLS management with obvious impact on early, but also on late outcome (19,21). Indeed, it is now increasingly evident that ECLS patients, based on the current ECLS management, may undergo substantial insult which are recognizable only after hospital discharge with appropriate counselling and evaluation, making therefore a neurocognitive surveillance a mandatory action in such a field, particularly in pediatric patients (19).…”

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confidence: 99%

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Extracorporeal life support and neurologic complications: still a long way to go

Lorusso

2017

J. Thorac. Dis.

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The actual impact of neurological complications on patient outcome during extracorporeal life support (ECLS) has emerged only since a few years (1,2) despite the use of such a temporary heart/lung support for more than four decades.The recent appraisal of the rather high incidence and ominous prognosis of these adverse events in ECLS patients have now alerted attending physicians and personnel upon continuous surveillance and early recognition. Nonetheless, it is increasingly evident that the mechanisms underlying the occurrence are not simply linked to embolization, bleeding, or low-flow related brain hypoxia (3-5) which were thought to represent the sole source of injury of the brain in ECLS patients.Following a study addressing the neurologic complications in the neonatal population (6), other two studies realized by analysing the Registry of the Extracorporeal Life Support Organization (ELSO), have recently investigated and clearly shown the entity of neurologic adverse events in veno-arterial (V-A) and veno-venous (V-V) ECLS configurations in adult patient populations (7,8). Incidence rates of brain injury were 15% in V-A and 7% in V-V patients, respectively, with an in-hospital survival of 10% in the first group, and 25% in the second, underlining the ominous prognosis once a neurological event occurs in the ECLS patients (7,8). These studies analyzed also the type of brain damage, according to the ELSO reporting system (embolism, hemorrhage, seizures, brain death) but also, more importantly, the trends of the overall CNS complications and of the single typerelated rates of such adverse events during a 20-year period whose assessment provided interesting findings (7,8).The difference of neurologic complication rates between V-A and V-V is not surprising. However, the two studies, as also highlighted by the comments provided by Pappalardo, Hirose, and Perico herewith enclosed (9-11), have provided several relevant clues for further interpretation and discussion. Interestingly, the incidence of CNS events in V-A ECLS patients steadily declined in the recent years, whereas no substantial change was observed in the V-V ECLS population (7,8). It is well-known that patients undergoing V-A ECLS, by definition and as also confirmed by the ELSO Registry data, are usually more prone to experience bleeding and hemodynamic instability after ECLS implant than V-V cases, therefore at higher risk also for brain injury. This is due to either the underlying disease, settings, and clinical conditions of the ECLS candidates or to the ECLS access (arterial cannulation certainly at higher risk of bleeding than venous access). V-A ECLS, indeed, is often applied nowadays in patients suffering from cardiac arrest, condition which is directly linked to brain hypoperfusion

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Psychiatric Outcome after Severe Cardio-Respiratory Failure Treated with Extracorporeal Membrane Oxygenation: A Case-Series

Cited by 24 publications

References 36 publications

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis

Extracorporeal support for patients with acute respiratory distress syndrome

Extracorporeal life support and neurologic complications: still a long way to go

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