Quality of Life and Lung Function in Survivors of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Survivors of acute respiratory distress syndrome (ARDS) have long-term impairment of pulmonary function and health-related quality of life, but little is known of outcomes of ARDS survivors treated with extracorporeal membrane oxygenation. The aim of this study was to compare long-term outcomes of ARDS patients treated with or without extracorporeal membrane oxygenation. Methods A prospective, observational study of adults with ARDS (January 2013 to December 2015) was conducted at a single center. One year after discharge, survivors underwent pulmonary function tests, computed tomography of the chest, and health-related quality-of-life questionnaires. Results Eighty-four patients (34 extracorporeal membrane oxygenation, 50 non–extracorporeal membrane oxygenation) were studied; both groups had similar characteristics at baseline, but comorbidity was more common in non–extracorporeal membrane oxygenation (23 of 50 vs. 4 of 34, 46% vs. 12%, P < 0.001), and severity of hypoxemia was greater in extracorporeal membrane oxygenation (median Pao2/Fio2 72 [interquartile range, 50 to 103] vs. 114 [87 to 133] mm Hg, P < 0.001) and respiratory compliance worse. At 1 yr, survival was similar (22/33 vs. 28/47, 66% vs. 59%; P = 0.52), and pulmonary function and computed tomography were almost normal in both groups. Non–extracorporeal membrane oxygenation patients had lower health-related quality-of-life scores and higher rates of posttraumatic stress disorder. Conclusions Despite more severe respiratory failure at admission, 1-yr survival of extracorporeal membrane oxygenation patients was not different from that of non–extracorporeal membrane oxygenation patients; each group had almost full recovery of lung function, but non–extracorporeal membrane oxygenation patients had greater impairment of health-related quality of life.

Outcomes of Post-traumatic Acute respiratory distress syndrome (ARDS) with and without Extracorporeal membrane oxygenation (ECMO) at A Level-1 Trauma Center

“…Comparison of the long-term outcomes of ARDS patients treated with ECMO and conventional ventilation strategies showed no signi cant difference in the 1-year survival but the non-ECMO group had greater impairment of health-related quality of life [30]. It has been suggested that the long-term functional limitation in ARDS survivors is not related to the degree of pulmonary dysfunction at admission, but rather to the consequences of invasive treatment at ICU and severity of illness [22,31].…”

A review on extracorporeal membrane oxygenation and kidney injury

“…[ 19,20 ] ECMO is also known to be percutaneous cardiopulmonary bypass, emergency cardiopulmonary bypass, portable cardiopulmonary bypass, or percutaneous cardiopulmonary support. [ 21 ]…”

Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

“…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.…”

“…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 ]. However, another prospective cohort study recently reported that pulmonary function was almost normal in 33 ECMO survivors from ARDS at the 365-day follow-up period [ 16 ]. Thus, the worsening QOL in ECMO survivors due to decreased pulmonary function remains controversial, and its impact on long-term mortality has not yet been clarified.…”