One-Year Mental and Physical Health Assessment in Survivors after Extracorporeal Membrane Oxygenation for COVID-19-related Acute Respiratory Distress Syndrome

Abstract

Rationale: Long-term outcomes of patients with coronavirus disease (COVID-19)-related acute respiratory distress syndrome treated with extracorporeal membrane oxygenation (ECMO) are unknown. Objectives: To assess physical examination, pulmonary function tests, anxiety, depression, post-traumatic stress disorder and quality of life at 6 and 12 months after ECMO onset. Methods: Multicenter, prospective study in patients who received ECMO for COVID-19 acute respiratory distress syndrome from March to June 2020 and survived hospital discharge. Measurements and Main Results: Of 80 eligible patients, 62 were enrolled in seven French ICUs. ECMO and invasive mechanical ventilation duration were 18 (11-25) and 36 (27-62) days, respectively. All were alive, but only 19/50 (38%) returned to work and 13/42 (31%) had recovered a normal sex drive at 1 year. Pulmonary function tests were almost normal at 6 months, except for Dl_CO, which was still impaired at 12 months. Mental health, role-emotional, and role-physical were the most impaired domain compared with patients receiving ECMO who did not have COVID-19. One year after ICU admission, 19/43 (44%) patients had significant anxiety, 18/43 (42%) had depression symptoms, and 21/50 (42%) were at risk for post-traumatic stress disorders. Conclusions: Despite the partial recovery of the lung function tests at 1 year, the physical and psychological function of this population remains impaired. Based on the comparison with long-term follow-up of patients receiving ECMO who did not have COVID-19, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation.

Keywords: COVID-19; acute respiratory distress syndrome; follow-up studies; quality of life; venovenous–extracorporeal membrane oxygenation.

Figure 1.

Saint George’s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale–Anxiety (HAD-A), HAD–Depression (HAD-D), Post-traumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), and Functional Assessment Chronic Illness Therapy-Fatigue (FACIT) assessments at 6 and 12 months in survivors after extracorporeal membrane oxygenation (ECMO) for coronavirus disease (COVID-19) severe acute respiratory distress syndrome. Whisker plots after 6 and 12 months of follow-up after COVID-19–related acute respiratory distress syndrome treated by ECMO are shown. The interior horizontal lines correspond to the median, the lower and upper box limits are the 25th and 75th percentiles, and the T-bars represent the range. The dotted line shows the threshold of clinical significance (for instance, a score ⩾8 for the anxiety and depression subscales, a score ⩾38 for PCL-5, and a score ⩽35 for FACIT). SGRQ was available for 42 and 36 patients at 6 and 12 months. FACIT was available for 46 and 41 patients at 6 and 12 months. HADS and PCL-5 were available for 50 and 43 patients at 6 and 12 months. HADS = Hospital Anxiety and Depression Scale; M6 = 6 months; M12 = 12 months.

Figure 2.

Extent and distribution of pulmonary opacities over time. Semiquantitative computed tomography (CT) score was assigned based on the area involved in all lung lobes, as follows: 1, 1–25% involvement; 2, 25–50% involvement; 3, 50–75% involvement; and 4, >75% involvement during ECMO, after 6 and 12 months of follow-up after COVID-19 related ARDS. CT patterns were described as follows: ground-glass, consolidation, and fibrotic-like changes (reticulation, honeycombing, bronchiectasis). ARDS = acute respiratory distress syndrome; COVID-19 = coronavirus disease; ECMO = extracorporeal membrane oxygenation; M6 = 6 months; M12 = 12 months.

Figure 3.

Comparison of 36-Item Short-Form Health Survey questionnaire scores of 62 survivors of coronavirus disease (COVID-19) acute respiratory distress syndrome (ARDS) treated by extracorporeal membrane oxygenation (ECMO) at 6 and 12 months with 67 patients with non-COVID ARDS treated by ECMO (8), and 51 conventionally treated survivors of COVID-19 ARDS at 1 year of follow-up (23). Higher scores denote a better health-related quality of life. BP = body pain; GH = general health; M6 = 6 months; M12 = 12 months; MH = mental health; PF = physical functioning; RE = role emotional; RP = role physical; SF = social functioning; VT = vitality.