Long-term survival and quality of life after extracorporeal life support: a 10-year report†

Camboni, Daniele; Philipp, Alois; Rottenkolber, Verena; Zerdzitzki, Matthaeus; Holzamer, Andreas; Floerchinger, Bernhard; Lunz, Dirk; Mueller, Thomas; Schmid, Çhristof; Diez, Claudius

doi:10.1093/ejcts/ezx100

Cited by 24 publications

(27 citation statements)

References 18 publications

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“…3,7,23,24,26,27 Our registered levels of psychological distress are low compared with those of several other studies using the HADS. 9 Our 50% returnto-work rate is higher than that found by Hodgson et al 28 and Camboni et al 26 but lower than that reported by Tramm et al, 3 where two-thirds of the sample had returned to work by 1 year after ECMO treatment. 3 Somewhat at odds with this finding, Risnes et al found high rates of psychiatric morbidity several years after ECMO treatment, even in the survivors with no history of psychiatric disorder prior to ECMO treatment.…”

Section: Discussioncontrasting

confidence: 70%

“…2,4,5,[23][24][25] High rates of return to independence in self-care and daily activities, as found in the present study, have also been reported previously in other studies using the EQ-5D descriptive system. 3,7,23,24,26,27 Our registered levels of psychological distress are low compared with those of several other studies using the HADS. 2,3,5,9,10 In a prospective longitudinal study, Tramm et al found that mental health improved during the first year after ECMO and that psychological distress was higher in survivors who received psychological care prior to ECMO treatment.…”

Section: Discussioncontrasting

confidence: 70%

“…3 Somewhat at odds with this finding, Risnes et al found high rates of psychiatric morbidity several years after ECMO treatment, even in the survivors with no history of psychiatric disorder prior to ECMO treatment. 9 Our 50% returnto-work rate is higher than that found by Hodgson et al 28 and Camboni et al 26 but lower than that reported by Tramm et al, 3 where two-thirds of the sample had returned to work by 1 year after ECMO treatment.…”

Section: Discussioncontrasting

confidence: 50%

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Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

et al. 2019

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Aims The aims of this study were to evaluate health‐related quality of life (HRQL) among patients treated with extracorporeal membrane oxygenation (ECMO) in northern Norway over a period of 27 years (1988–2015) and to identify variables related to HRQL. Methods and results A retrospective inquiry of the ECMO registry at the University Hospital of North Norway identified 74 ECMO‐treated patients (mean age 49 years, 65% males). Acute cardiac failure was the dominant indication (58%), and venoarterial ECMO was the dominant mode of treatment (87%). Mortality for discharged patients was recorded on 20 September 2016. Thirty (41%) survivors were identified. Twenty‐three survivors were eligible for the survey and received a set of questionnaires at home. The main outcome measure was HRQL as measured with the 36‐item Short‐Form health survey (SF‐36) (RAND Short Form‐36 v1.2). Other questionnaires covered demographic information, problems with functioning in usual daily activities (such as hobbies, household chores, family, or work), employment status, and psychological distress. The survey was completed by 20 (87%) survivors (mean age = 49 years, 12 men). Indications for ECMO treatment (VA = 90%) had been respiratory failure (25%), cardiac failure (60%), and extracorporeal cardiopulmonary resuscitation (15%). The average time since ECMO treatment was 6.5 years. Seventy‐five percent reported mental HRQL (SF‐36 Mental Component Summary, mean = 43, SD = 5) or physical HRQL (SF‐36 Physical Component Summary, mean = 43, SD = 4.5) within the normal range (T = 50 ± 10) in comparison with age‐matched population data from national norms. Half of the responders reported problems on the SF‐36 subscales general health and role physical. Seventy percent reported problems on the SF‐36 subscale role emotional. All but one responder lived independently without any organized care, and 90% reported no problems related to basic self‐care. Half of those in working age had returned to work after ECMO treatment. Forty percent of the responders reported some degree of restrictions in usual daily activities, problems with mobility (35%), anxiety/depression (35%), or pain/discomfort (55%). Significant univariate associations were observed for poorer HRQL and higher reports of psychological distress, pain, and experiencing restrictions in usual everyday activities. Improved HRQL was significantly related to an extended time since ECMO treatment. Conclusions Our survey indicates an overall positive long‐term HRQL outcome for our ECMO survivors. A subset reported problems with functioning and HRQL. Future research should focus on identification of the survivors at risk for poor recovery who may benefit from rehabilitation interventions.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussioncontrasting

confidence: 70%

Section: Discussioncontrasting

confidence: 50%

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Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

et al. 2019

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“…The concomitant use of an intraaortic balloon pump (IABP) with ECMO as the easiest method to decompress the left ventricle is not part of our protocol, neither is the use of an Impella device. The overall survival rate to discharge of our entire cohort including nearly 50% of ECPR cases is 37% in accordance with the Extracorporeal Life Support Organization (ELSO) registry and similar to the published VA ECMO literature (16). The low rate of LV venting in our population is explained by our policy of strict afterload reduction, accepting a mean arterial pressure of <50 mmHg even with no pulsatility for a period of 24 h and sometimes even longer, low flow rates of 3-4 L/min as long as lactate levels decrease, a restrictive fluid management, as well as the application of higher positive end expiratory pressure values to decrease pulmonary edema.…”

supporting

confidence: 86%

To vent or not on veno-arterial extracorporeal membrane oxygenation, does it improve myocardial recovery and outcome?

Camboni¹,

Schmid²

2017

J. Thorac. Dis.

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“…It is seen that 75% of the survivors after ECLS are able to go about their daily life, 25% of them return to work or school, and 57% of them are not limited in their usual activities. However, when compared to a normative age-matched population, significantly lower quality-of-life indices are reported [76].…”

Section: Va-ecmomentioning

confidence: 76%

Cardiogenic Shock

Türker¹

2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short-and long-term survival of patients.to survive [2]. CS occurs in approximately 5-8% of inpatients with ST-elevation myocardial infarctions (STEMI) and has a mortality rate of more than 30% [1]. CS is caused by end-organ hypoperfusion due to impaired cardiac pump function. Although CS-related mortality has declined significantly over the past decade, it continues to remain high, especially in cases of its coexistence with ischemic heart disease. Acute coronary syndrome (ACS) is still the most common cause of CS despite significant advances that have been made in its diagnosis and treatment. The most successful form of treatment is primary percutaneous coronary intervention (pPCI), which is carried out as rapidly as possible [3]. The recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems also play a role in the pathogenesis and persistence of CS.In cases where CS complicates MI (CSMI), only one in two patients survives after 1 year [4,5]. In a large study including 5782 patients, CSMI had developed in 2.5% of the patients with STEMI before admission to hospital, in 4.3% of them on the first day of hospitalization, and in 2.3% of them afterward [6]. For non-STEMI (NSTEMI) patients, these ratios were 1.2% for each condition [6]. Mortality rates were 45.7% before the hospitalization, 32.8% in the early period, and 54.1% in the late period [7]. Of 1422 CSMI patients, in the SHOCK Trial Registry, a shock is developed following left ventricular failure in 78.5% of them, acute mitral insufficiency in 6.9% of them, acute ventricular septal defect in 3.9% of them, right ventricular failure in 2.8% of them, cardiac tamponade in 1.4% of them, and ...

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Long-term survival and quality of life after extracorporeal life support: a 10-year report†

Abstract: Long-term survival rates in patients requiring extracorporeal life support are acceptable with a probable advantage for patients without an operation and a narrowed QOL. The results are promising and encouraging, but there is also a need for improvement.

Cited by 24 publications

References 18 publications

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

Health‐related quality of life after extracorporeal membrane oxygenation: a single centre's experience

To vent or not on veno-arterial extracorporeal membrane oxygenation, does it improve myocardial recovery and outcome?

Cardiogenic Shock

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