Long-Term Survival and Health-Related Quality of Life in Adults After Extra Corporeal Membrane Oxygenation

Abstract

Background: The study aims to determine long-term survival, health-related quality of life (HRQoL) and functional and physical outcomes of adult extra corporeal membrane oxygenation (ECMO) patients as there are limited and conflicting data in this area.

Methods: All patients receiving ECMO from April 2009 until June 2014 at The Prince Charles Hospital, Brisbane had Kaplan Meier survival calculated. Quality of life (QoL) was assessed using the Short Form Health Survey (SF-36v2), EQ5D-5L, The Frenchay Activities Index (FAI) and a return to work survey. From December 2011, these measures and 6-minute walk distance (6MWD) were assessed at hospital discharge and 12 months post-discharge.

Results: Seventy-seven (77) patients (45 veno-arterial and 32 veno-venous) received ECMO of whom 47/77 (61%) survived to hospital discharge. There were no deaths recorded in those discharged alive from the intensive care unit at median follow-up time 1,011days (range 227-2,014 days). Mean SF-36 scores (n=33) and EQ5D were assessed at a median of 606days after hospital discharge. SF-36 scores were significantly (p<0.05) worse than age-matched norms in all domains except vitality, bodily pain and mental health. Thirteen (13) (39%) participants had persistent problems with mobility and usual activity as measured by EQ5D. At 12 months post-ECMO, 6MWD was 531(IQR:397.3-626.8)m; 72% (IQR:53.2-77.6%) predicted but had improved by 223m (p=0.002) when compared to baseline. Nineteen (19) of 20 participants who had been employed pre-ECMO had returned to work.

Conclusions: All ECMO patients discharged from hospital were alive at follow-up. Despite improvements in physical measures and HRQoL, long-term functional deficits persist when compared to that of aged- and sex-matched norms.

Keywords: ECMO; Outcomes; Quality of Life; Survival.