Abstract
IntroductionThe purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia.MethodsA retrospective observational study with prospective health related quality of life (HRQoL) assessment was conducted in ARDS patients who had ECMO as a rescue therapy for reversible refractory hypoxemia from January 2009 until April 2011 in a tertiary Australian centre. Survival and long-term quality of life assessment, using the Short-Form 36 (SF-36) and the EuroQol health related quality of life questionnaire (EQ5D) were assessed and compared to international data from other research groups.ResultsTwenty-one patients (mean age 36.3 years) with ARDS receiving ECMO for refractory hypoxemia were studied. Eighteen (86%) patients were retrieved from external intensive care units (ICUs) by a dedicated ECMO retrieval team. Eleven (55%) had H1N1 influenza A-associated pneumonitis. Eighteen (86%) patients survived to hospital discharge. Of the 18 survivors, ten (56%) were discharged to other hospitals and 8 (44%) were discharged directly home. Sequelae and health related quality of life were evaluated for 15 of the 18 (71%) long-term survivors (assessment at median 8 months). Mean SF-36 scores were significantly lower across all domains compared to age and sex matched Australian norms. Mean SF-36 scores were lower (minimum important difference at least 5 points) than previously described ARDS survivors in the domains of general health, mental health, vitality and social function. One patient had long-term disability as a result of ICU acquired weakness. Only 26% of survivors had returned to previous work levels at the time of follow-up.ConclusionsThis ARDS cohort had a high survival rate (86%) after use of ECMO support for reversible refractory hypoxemia. Long term survivors had similar physical health but decreased mental health, general health, vitality and social function compared to other ARDS survivors and an unexpectedly poor return to work.
Highlights
The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia
Several studies have reported that ECMO may improve survival in severe ARDS, but it is potentially associated with serious complications [12,13,14] and there have been few studies to review long-term survival and quality of life of ARDS patients following ECMO support [15,16,17,18]
In a recent study of ARDS survivors from France, survivors who received ECMO as a rescue therapy had lower health-related quality of life (HRQoL) compared to a French age- and sex-matched general population at one year but not lower than age- and sexmatched survivors of severe ARDS who were not treated with ECMO [18]
Summary
The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. Several studies have reported that ECMO may improve survival in severe ARDS, but it is potentially associated with serious complications [12,13,14] and there have been few studies to review long-term survival and quality of life of ARDS patients following ECMO support [15,16,17,18]. In a recent study of ARDS survivors from France, survivors who received ECMO as a rescue therapy had lower HRQoL compared to a French age- and sex-matched general population at one year but not lower than age- and sexmatched survivors of severe ARDS who were not treated with ECMO [18]
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