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. 2023 Sep 1;51(9):1234-1245.
doi: 10.1097/CCM.0000000000005900. Epub 2023 May 1.

Sounding the Alarm: What Clinicians Need to Know about Physical, Emotional, and Cognitive Recovery After Venoarterial Extracorporeal Membrane Oxygenation

Kelly C Higa  1 , Kirby Mayer  2 , Christopher Quinn  3 , Lindsey Jubina  2 , Alejandro Suarez-Pierre  3 , Kathryn Colborn  3 , Sarah E Jolley  4 , Kyle Enfield  5 , Joseph Zwischenberger  6 , Carla M Sevin  7 , Jessica Y Rove  8
Affiliations

Sounding the Alarm: What Clinicians Need to Know about Physical, Emotional, and Cognitive Recovery After Venoarterial Extracorporeal Membrane Oxygenation

Kelly C Higa et al. Crit Care Med. .

Abstract

Objective: We summarize the existing data on the occurrence of physical, emotional, and cognitive dysfunction associated with postintensive care syndrome (PICS) in adult survivors of venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Data sources: MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched.

Study selection: Peer-reviewed studies of adults receiving VA-ECMO for any reason with at least one measure of health-related quality of life outcomes or PICS at long-term follow-up of at least 6 months were included.

Data extraction: The participant demographics and baseline characteristics, in-hospital outcomes, long-term health outcomes, quality of life outcome measures, and prevalence of PICS were extracted.

Data synthesis: Twenty-seven studies met inclusion criteria encompassing 3,271 patients who were treated with VA-ECMO. The studies were limited to single- or two-center studies. Outcomes variables and follow-up time points evaluated were widely heterogeneous which limits comprehensive analysis of PICS after VA-ECMO. In general, the longer-term PICS-related outcomes of survivors of VA-ECMO were worse than the general population, and approaching that of patients with chronic disease. Available studies identified high rates of abnormal 6-minute walk distance, depression, anxiety, and posttraumatic stress disorder that persisted for years. Half or fewer survivors return to work years after discharge. Only 2 of 27 studies examined cognitive outcomes and no studies evaluated cognitive dysfunction within the first year of recovery. No studies evaluated the impact of targeted interventions on these outcomes.

Conclusions: Survivors of VA-ECMO represent a population of critically ill patients at high risk for deficits in physical, emotional, and cognitive function related to PICS. This systematic review highlights the alarming reality that PICS and in particular, neurocognitive outcomes, in survivors of VA-ECMO are understudied, underrecognized, and thus likely undertreated. These results underscore the imperative that we look beyond survival to focus on understanding the burden of survivorship with the goal of optimizing recovery and outcomes after these life-saving interventions. Future prospective, multicenter, longitudinal studies in recovery after VA-ECMO are justified.

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Conflict of interest statement

Dr. Sevin’s institution received funding from the Department of Defense. The remaining authors have disclosed that they do not have any potential conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram of methods. HRQOL = health-related quality of life, VA-ECMO = venoarterial extracorporeal membrane oxygenation.
Figure 2.
Figure 2.
Summary of studies. The top panel is a graphical representation of the indication for VA-ECMO and what instrument was used to evaluate in-hospital, physical cognitive, and mental health outcomes, and whether the study reported return to work or healthcare costs. The bottom panel provides follow-up timepoints for cross-sectional and longitudinal studies. BDI-II = Beck Depression Inventory, second edition, EQ-5D = EuroQOL 5-dimension questionnaire, HADS = Hospital Anxiety and Depression Scale, HTx = heart transplant, IES-R = Impact of Event Scale, Revised, KCCQ = Kansas City Cardiomyopathy Questionnaire, MoCA = Montreal Cognitive Assessment, NYHA = New York Heart Association, PF = physical functioning, PHQ-9 = patient health questionnaire 9, SF-36 = Short Form 36-Item Health Survey, VAD = ventricular assist device, VA-ECMO = venoarterial extracorporeal membrane oxygenation, WHOQOL = World Health Organization QOL.
Figure 3.
Figure 3.
Summary of Short Form 36-Item Health Survey (SF-36) data. Summary of SF-36 data for venoarterial extracorporeal membrane oxygenation (VA-ECMO) Survivors compared with the General Population (A) or Individuals with Chronic Disease (B). SF-36 Domains: physical functioning (PF), role limitations due to physical health problems (RP), role limitation due to emotional problems (RE), social functioning (SF), bodily pain (BP), energy/fatigue or vitality (VT), emotional well-being or mental health (MH), and general health perceptions (GH). SF-36 Summary Scores: physical component summary (PCS) and mental component summary (MCS).
Figure 4.
Figure 4.
Long-term outcomes for patients surviving venoarterial extracorporeal membrane oxygenation (VA-ECMO). Future studies evaluating the long-term outcomes of patients surviving VA-ECMO should consider the indications for VA-ECMO and in-hospital outcomes in addition to short-term posthospital utilization and long-term outcomes (6). VA-ECMO = venoarterial extracorporeal membrane oxygenation.
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