Needs Based Assessment of COVID-19 ECMO and Non-COVID-19 ECMO Survivors, a Descriptive and Thematic Analysis

Abstract

RATIONALE Intensive Care Unit (ICU) survivors are apt to suffer from features of the Post-Intensive Care Syndrome (PICS) and therefore, benefit from care by experts in specialized post-ICU clinics. Historically, ECMO (Extracorporeal Membrane Oxygenation) survivors have been excluded from studies on PICS or their needs have been aggregated with other non-ECMO post-ICU survivors. We sought to assess the needs and experiences of ECMO survivors and to determine if these varied depending on whether the patient required ECMO for COVID-19. METHODS We conducted in-depth semi-structured interviews via telephone with post-ECMO survivors who were seen or eligible to be seen in our Post-ICU Recovery Clinic from January 1, 2020 through December 1, 2020. All interviews were audio recorded and transcribed verbatim. A qualitative codebook was developed using the constant comparative method to identify themes. Disagreements were discussed and resolved by consensus. RESULTS Of 35 ECMO survivors, we interviewed 13 (6 COVID-19 ECMO, 7 Non-COVID-19 ECMO). We identified four major themes: 1) challenges at hospital discharge;2) strategies to overcome challenges;3) benefits of a recovery clinic;and 4) growth areas. COVID-19 ECMO survivors were more likely to endorse dyspnea as a persistent symptom and to discuss faith and gratitude as a strategy to overcome challenges. In contrast, non-COVID-19 patients were more likely to suffer from psychological sequelae and to seek peer support groups. Both groups discussed the obstacle of ambulatory dysfunction and the importance of home rehabilitation services. Both groups valued the continuity of care, access to information, and the telemedicine capabilities of the post-ICU clinic (Table 1). CONCLUSION Based upon our work and previously published data, some overlap exists between the needs and experiences of post-ICU and post-ECMO survivors. Patients with COVID-19 may represent a sub-phenotype of post-ECMO survivors with unique experiences and needs during their recovery period. Ongoing work involving a larger patient population is underway to better determine the experiences and needs associated with ECMO survivors. This is especially prudent as our population of both ICU and ECMO survivors expands during the ongoing COVID-19 pandemic.