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Multicenter Study
. 2023 Nov 14;27(1):440.
doi: 10.1186/s13054-023-04724-y.

Functional recovery in a cohort of ECMO and non-ECMO acute respiratory distress syndrome survivors

Mackenzie Snyder  1 , Binta Y Njie  1 , Ilana Grabenstein  1 , Sara Viola  2 , Hatoon Abbas  3 , Waqas Bhatti  3 , Ryan Lee  3 , Rosalie Traficante  3 , Siu Yan Amy Yeung  4 , Jonathan H Chow  5 , Ali Tabatabai  6 , Bradley S Taylor  7 , Siamak Dahi  7 , Thomas Scalea  8 , Joseph Rabin  8 , Alison Grazioli  9 , Carolyn S Calfee  10 , Noel Britton #  11 , Andrea R Levine #  12
Affiliations
Multicenter Study

Functional recovery in a cohort of ECMO and non-ECMO acute respiratory distress syndrome survivors

Mackenzie Snyder et al. Crit Care. .

Abstract

Background: The mortality benefit of VV-ECMO in ARDS has been extensively studied, but the impact on long-term functional outcomes of survivors is poorly defined. We aimed to assess the association between ECMO and functional outcomes in a contemporaneous cohort of survivors of ARDS.

Methods: Multicenter retrospective cohort study of ARDS survivors who presented to follow-up clinic. The primary outcome was FVC% predicted. Univariate and multivariate regression models were used to evaluate the impact of ECMO on the primary outcome.

Results: This study enrolled 110 survivors of ARDS, 34 of whom were managed using ECMO. The ECMO cohort was younger (35 [28, 50] vs. 51 [44, 61] years old, p < 0.01), less likely to have COVID-19 (58% vs. 96%, p < 0.01), more severely ill based on the Sequential Organ Failure Assessment (SOFA) score (7 [5, 9] vs. 4 [3, 6], p < 0.01), dynamic lung compliance (15 mL/cmH20 [11, 20] vs. 27 mL/cmH20 [23, 35], p < 0.01), oxygenation index (26 [22, 33] vs. 9 [6, 11], p < 0.01), and their need for rescue modes of ventilation. ECMO patients had significantly longer lengths of hospitalization (46 [27, 62] vs. 16 [12, 31] days, p < 0.01) ICU stay (29 [19, 43] vs. 10 [5, 17] days, p < 0.01), and duration of mechanical ventilation (24 [14, 42] vs. 10 [7, 17] days, p < 0.01). Functional outcomes were similar in ECMO and non-ECMO patients. ECMO did not predict changes in lung function when adjusting for age, SOFA, COVID-19 status, or length of hospitalization.

Conclusions: There were no significant differences in the FVC% predicted, or other markers of pulmonary, neurocognitive, or psychiatric functional recovery outcomes, when comparing a contemporaneous clinic-based cohort of survivors of ARDS managed with ECMO to those without ECMO.

Keywords: ARDS; COVID-19; ECMO; Functional recovery; Long-term outcomes; Pulmonary function tests.

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Conflict of interest statement

JHC has served on the speakers bureau for La Jolla, Pharmaceutical Company and has received consulting fees from Exthera Medical, outside the scope of the submitted work.

Figures

Fig. 1
Fig. 1
Study consort diagram
Fig. 2
Fig. 2
FVC% predicted comparing A ECMO (red) to non-ECMO (yellow) patients; B ECMO (red) to "ECMO eligible" (teal) patients. ns = non-significant by the Mann–Whitney U test
See this image and copyright information in PMC

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