Veno-venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) is an established support for severe adult respiratory distress. Previous studies have showed improvement in survival over conventional treatment for ARDS, however little is known about the medium term impact of ECMO on patients, lung physiology and quality of life (QoL). This study investigates these factors in a cohort of patients post-ECMO.
All VV-ECMO survivors at a national cardiothoracic centre were offered follow-up six months post-discharge. Thirty-four patients were followed over a three-year period. We examined lung physiology, six-minute walk distance, chest X-rays and change in BMI. QoL subjective measures included mobility, self-care, psychological state and pain scores.
Mean duration of ECMO support was 14.5 days (± 10.2; range = 3–40 days). Indications were infective (22/34), embolic (4/34), bronchospasm (4/34), trauma (3/34) and drug overdose (1/34). There was insignificant correlation between indication/ECMO duration and lung physiology at six months, with good recovery in all lung physiology parameters (%FEV1 mean = 88.0% ± 16.9; %FVC mean = 93.1% ± 16.2) with the exception of TLCO%predicted (mean = 76.6% ± 16.6). This however didn’t translate into a measureable difference in exercise physiology, with no correlation between six-minute walk distance and ECMO duration (R2 = 0.0022, mean = 424 m ± 82.5). Seventy-nine percent of 29 X-rays assessed were normal.
Mean BMI change during ECMO admission was -6.87% ± 11.99 with greater BMI decline alongside longer ECMO support. Interestingly, post-discharge men regained most weight by follow-up whereas females continued to lose (Figure 1).
No significant correlations were seen between ECMO length, indication, and QoL measures. Qualitative analysis suggests worsening anxiety/depression amongst 13 (6 M 7F) patients/family members post-ECMO; four patients giving unprompted mention of flashbacks/nightmares.
ECMO offers undoubted short term improvement in ARDS mortality. In this cohort, recovery of lung physiology, chest radiology and QoL is good. The isolated transfer factor reduction probably relates to a loss of functioning alveolar units but doesn’t appear to impact exercise physiology or QoL. The main lasting impact appears to be psychological. In the absence of a control group, the impact of critical illness is difficult to separate from that of ECMO, however in this uncontrolled single centre observational study much reassurance can be gained about medium term impact of ECMO.