Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

Taylor, Lauren J.; Jolley, Sarah E.; Ramani, Chintan; Mayer, Kirby P.; Etchill, Eric; Mart, Matthew F.; Fakhri, Shoaib; Peterson, Skyler; Colborn, Kathryn; Sevin, Carla M.; Kadl, Alexandra; Enfield, Kyle B.; Whitman, Glenn; Zwischenberger, Joseph B.; Rove, Jessica Y.; Montgomery-Yates, Ashley; Parker, Ann M.; Teman, Nicholas R.; Hoffman, Jordan; Bartels, Karsten; Kim, Bo Soo; Cho, Sung Min; Hippensteel, Joseph A.

doi:10.1016/j.jtcvs.2021.11.099

Cited by 10 publications

(13 citation statements)

References 28 publications

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“…First, the study population is limited and consists of a highly selected group of young, physically fit, and generally healthy patients, with relatively low SOFA and SAPS II scores. If the number of patients whose outcome is described is at least similar to the previously reported COVID-19 ECMO populations, 34–37 patients characteristics are consistent with the actual recommendation for ECMO candidacy in COVID-19 ARDS. 4 Moreover, we did not perform a direct comparison between COVID-19 ARDS and ARDS from other etiologies.…”

Section: Discussionmentioning

confidence: 65%

“…Our results are consistent with previous studies on classical ARDS patients treated 23 or not 24 with ECMO, whereas studies on COVID-19 ECMO population reported a wide range of anxiety prevalence, from 10 to 40%. 34,36 The interaction between physical function and psychological factors play a complex and mostly not fully elucidated role in patient outcomes. Consistently to previous studies, we observed a trend toward improvement of psychological symptoms over time (i.e., reduction in anxiety prevalence and PCL-5 score), and this was parallel to the improvement in physical performance (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study

Pozzi,

Giani,

Andreossi

et al. 2023

ASAIO Journal

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Extracorporeal membrane oxygenation (ECMO) has been used in highly selected COVID-19 patients with severe respiratory failure. Scarce data exist on long-term outcomes of these patients. We performed a single-center prospective evaluation of consecutive COVID-19 ECMO patients successfully discharged from the intensive care unit between February 2020 and January 2022. Physical, cognitive and psychological outcome was assessed at 3, 6, and 12 months by in-person evaluation. All the 34 discharged patients (median age 49 years old) were alive at one year, and 25 of them were evaluated at the follow-up clinic. 67% of patients had muscle weakness, with improvement over time (p = 0.032). The percentage of patients able to return to work progressively increased, up to 86% at 1 year. 23% of patients experienced fatigue. Participation restriction improved over time for both physical (p = 0.050) and emotional (p = 0.005) problems. Cognitive impairment, anxiety, and depression occurred in 29%, 29%, and 23% of patients, respectively, with no changes over time. Health-related quality of life was good. In conclusion, COVID-19 ECMO patients suffer from significant long-term sequelae. However, multidimensional outcomes continued to improve over the follow-up time.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study

Pozzi,

Giani,

Andreossi

et al. 2023

ASAIO Journal

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“…Race and/or ethnicity was the primary study aim in five citations (13%). No statistical difference or mixed results were observed in 25 (64%) of studies (51, 52, 135–147). Studies with cardiac disease, arrest, transplant, or shock observed patients from diverse backgrounds having lower ECMO use in seven (28, 31, 129, 148–151) versus higher ECMO use in three (26, 89, 152).…”

Section: Resultsmentioning

confidence: 86%

“…Of 16 U.S. studies, four found no difference (31, 139, 159, 165), 10 showed greater use in patients with private insurance (vs government insurance) (28, 89, 129, 132, 137, 148, 154, 160, 166) or any insurance (vs uninsured) (167). One obstetric study observed higher ECMO use with government insurance (155), and another showed lower ECMO use in insured patients with COVID-19 (138).…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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“…Data were incomplete, but although ECMO patients had more complex critical illness courses, posthospitalization deficits were comparably frequent in both groups. 28 ECMO patients were younger with less comorbidities which likely contributed to comparable outcomes, but some of the posthospitalization morbidity appears to be general phenomenon after COVID-19. The pathogenesis is not well understood, but persisting inflammation and immune-mediated responses have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Functional Status and Quality of Life 6 Months After Extracorporeal Membrane Oxygenation Therapy for COVID-19-Related Pulmonary Failure

et al. 2023

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Extracorporeal membrane oxygenation (ECMO) is increasingly used in COVID-19-related pulmonary failure and the number of patients recovering from COVID-19 is growing. Here, we assess survival and recovery 6 months after ECMO for COVID-19. From April 2020 to September 2021, n = 60 (60.5 [51.0–65.0] years, 23.3% female) were treated with venovenous/venoarterial ECMO for COVID-19. 41.7% were weaned off ECMO, survival-to-discharge was 40.0% (n = 24). Age (63.0 [60.0–66.8] vs. 55.0 [43.8–60.0] years, p < 0.001), vasoactive support (97.2% vs. 75.0%, p = 0.013), and pre-ECMO SOFA scores (13.0 [12.0–14.8] vs. 12.0 [10.0–13.8] p = 0.036) correlated with nonsurvival. All patients aged >65 years, with histories of neoplasia, immunocompromise, chronic renal failure, or frailty died. After 6 months, 20 were alive (6-month survival 33.3%, survival conditioned on survival-to-discharge 83.3%), with follow-up in 19. 57.9% showed no relevant, 26.3% moderate, 15.8% severe deficits. Cardiopulmonary status was satisfactory (mMRC level: 84.2% ≤2). 73.7% were independent in daily life. Cognitive impairments were frequent (52.6%). 26.3% showed moderate depression, 15.8% posttraumatic stress disorder. Social and work life were considerably affected. Extracorporeal membrane oxygenation thus can serve as salvage therapy in COVID-19, but advanced age, immunocompromise, histories of neoplasia, and frailty must be considered as relative contraindications. Age, vasoactive support, and SOFA scores assist discriminating in daily practice. Deficits after 6 months are substantial, and efforts need to focus on long-term recovery.

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Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

Cited by 10 publications

References 28 publications

Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study

Long-Term Physical, Cognitive, and Psychological Outcomes in Severe COVID-19 Patients Managed With Extracorporeal Membrane Oxygenation: A Prospective Study

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Functional Status and Quality of Life 6 Months After Extracorporeal Membrane Oxygenation Therapy for COVID-19-Related Pulmonary Failure

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