Long-term outcomes of survivors undergoing extracorporeal membrane oxygenation in Manitoba between 2007 and 2016

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) to treat severe cardiorespiratory illness has seen a marked increased in the last decade. Much of the data regarding this intensive therapy is short term in nature and focused on survival. There exists a need for assessment of long-term survival and health related quality of life (HRQoL) to improve our understanding of the benefits of this therapy. Methods: A retrospective chart review of all 239 patients supported with ECMO in Manitoba between 2007 and 2016 was performed as well as prospective long-term HRQoL analysis of the survivors, who were invited to undergo detailed HRQoL assessments involving eight questionnaires and three clinical assessments. Fifty-one patients, 38 undergoing venoarterial- ECMO and 13 venovenous-ECMO, were interviewed. Results: One hundred and eighty-four patients were supported with venoarterial-ECMO most commonly for cardiogenic shock (63%) where 30-day and 2-year survivals were 43.5% and 36.6% respectively. Fifty-five patients supported with venovenous-ECMO most commonly had acute respiratory distress syndrome (78%) where 30 day and 2 year survivals were 56.4% and 48.0% respectively. Two-year survival estimates for all patients surviving to hospital discharge were 85% for all patients. Twenty-nine percent of VA-ECMO and 43% of VV-ECMO patients reported having a low quality of life. Despite their younger age, VV-ECMO patients had greater deficits, including depression (23.1%), anxiety (38.5%), PTSD (38%) and low physical activity (53%). Conclusion: Survival, particularly of patients discharged from hospital, was reasonable on longterm follow-up but persistent issues with HRQoL were identified. This study provides better understanding of patient survival and issues post ECMO therapy, which may be used to counsel patients and families and identify areas for enhanced ongoing care.