Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used in highly selected COVID-19 patients with severe respiratory failure. Scarce data exist on long-term outcomes of these patients. We performed a single-center prospective evaluation of consecutive COVID-19 ECMO patients successfully discharged from the intensive care unit between February 2020 and January 2022. Physical, cognitive and psychological outcome was assessed at 3, 6, and 12 months by in-person evaluation. All the 34 discharged patients (median age 49 years old) were alive at one year, and 25 of them were evaluated at the follow-up clinic. 67% of patients had muscle weakness, with improvement over time (p = 0.032). The percentage of patients able to return to work progressively increased, up to 86% at 1 year. 23% of patients experienced fatigue. Participation restriction improved over time for both physical (p = 0.050) and emotional (p = 0.005) problems. Cognitive impairment, anxiety, and depression occurred in 29%, 29%, and 23% of patients, respectively, with no changes over time. Health-related quality of life was good. In conclusion, COVID-19 ECMO patients suffer from significant long-term sequelae. However, multidimensional outcomes continued to improve over the follow-up time.

Figure 1.

Study flow chart. Of 50 COVID-19 ECMO patients, 34 were successfully discharged from ICU, while 16 died while on extracorporeal membrane oxygenation (ECMO) support. All patients successfully weaned from ECMO were successfully discharge from hospital. Among survivors, 25 patients were evaluated at least once at follow-up clinic. Four patients were evaluated only once (1 patient at 3 months, 2 patients at 6 months and 1 patient at 12 months). Ten patients were evaluated twice (6 patients at 3 and 12 months and 4 patients at 6 and 12 months). Eleven patients were evaluated three times. ECMO, extracorporeal membrane oxygenation.

Figure 2.

Co-occurrence of physical impairments. Venn diagram showing impairment in three different areas of physical function. Each point indicates one patient. Points enclosed into a circle represent a group of patients suffering from a specific physical impairment. Points enclosed in more than one circle represent patients suffering for more than one physical impairment. Fifteen patients had an impairment in almost two dimensions of physical functioning. All but three patients with participation restriction experienced activity limitation or muscle weakness. Only four patients showed an impairment in all these three dimensions of physical function. Only in one case muscle weakness occurred without other physical impairment.