Problems and health needs of adult extracorporeal membrane oxygenation patients following hospital discharge: A qualitative study

Chen, K.-H.; Tsai, Feng‐Chun; Tsai, Chien‐Sung; Yeh, Shu-Ling; Weng, Li‐Chueh; Yeh, Li-Chyun

doi:10.1016/j.hrtlng.2015.12.005

Cited by 23 publications

(36 citation statements)

References 21 publications

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“…Over the 12 months following discharge, depressive symptoms declined and physical activity continued to improve. Our findings are consistent with a previous study [ 19 ], which demonstrated by one year following discharge, most ECLS survivors were able to take control of their lives and adjust to a new lifestyle. It is important to note that the mean total score for depression at 12-months was similar to the score at 3-months after discharge.…”

Section: Discussionsupporting

confidence: 93%

“…PCS scores increased significantly at 9 and 12 months after discharge. Adult ECLS patients have been reported to experience physical and psychological stress, especially during the first 6 months following hospital discharge, and at 12 months a small number continue to have complications of lower limb weakness and constraints in joint movement [ 19 ], which might lead to a reduction in overall general health for more than 3 years after hospital discharge [ 11 ]. PCS scores might also result from worry about experiencing another incidence of ECLS, which requires self-motivation for successful rehabilitation and emotional adaptation for their mental health after discharge [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Survivors of ECLS are reported to have significantly lower QOL based on scores for the physical and psychological domains of the Short-Form 36 (SF-36) when compared with a healthy population [ 11 , 13 , 17 ]; however, QOL for ECLS survivors was better than for patients with other serious or chronic diseases [ 11 , 18 ]. One qualitative study followed adult patients who survived ECLS for one year following hospital discharge; patients experienced different forms of physical and psychological stress, which varied with time after discharge [ 19 ]: 50% experienced lower limb problems at 6 months; and a small number continued to have limb weakness and constraints in joint movement at 12 months; and one patient’s health improved by 9 months, but his psychological status was poor, he lacked friends, and was unable to work full-time. Thus, it is important to understand changes in patterns of patients’ health conditions for the past, present, and projected future [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study

Chen

Yeh

et al. 2018

PLoS ONE

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BackgroundExtracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients’ survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study’s aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period.Study designA prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants’ QOL at 12 months after discharge was compared with the general population.ResultsA total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores.ConclusionsThis was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study

Chen

Yeh

et al. 2018

PLoS ONE

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“…While patients may experience some decrease in physical and psychological aspects of their daily life, many of those who survive to discharge have been able to return to work or school and report good quality of life with the help of rehabilitation programs. [ 12 13 14 15 ] It should be noted that this data does not come from the ACHD population.…”

Section: Discussionmentioning

confidence: 99%

The need for extracorporeal membrane oxygenation in adults undergoing congenital heart surgery: Impact and trends of utilization

Aiello

Loomba

Kriz

et al. 2017

Indian Journal of Critical Care Medicine

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Introduction:Adults with congenital heart disease (ACHD) represent a population with unique health-care needs. Many patients require cardiac surgery, with some requiring postoperative extracorporeal membrane oxygenation (ECMO). This study aimed to identify the risk factors for the need of postoperative ECMO and characterize the impact of ECMO on admission characteristics.Methods:Data from the 2005–2012 iterations of the Nationwide Inpatient Sample were used. ACHD admissions over 18 years with a documented cardiac surgery were included. Univariate analysis was conducted to compare the characteristics between those requiring ECMO and those who did not. Regression analysis was done to identify the independent risk factors associated with ECMO and to determine the impact of ECMO on length, cost, and mortality of the admission.Results:A total of 186,829 admissions were included. Of these, 446 (0.2%) admissions required ECMO. Those with acute kidney injury, double-outlet right ventricle, or total anomalous pulmonary venous connection were more likely to require ECMO. ECMO was also significantly more utilized in patients undergoing septal defect repair, complete repair of tetralogy of Fallot, atrial switch, and heart transplant. The use of ECMO significantly increased length, cost, and mortality of stay. Overall mortality was 62.6% in the ECMO group.Conclusion:ECMO is only needed in a small proportion of postoperative ACHD patients. The use of ECMO significantly increases cost, length of stay and mortality in these patients. Improved identification of postoperative ACHD patients who are more likely to survive ECMO may facilitate improved survival and decreased resource utilization.

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“…Despite mounting evidence that ECMO patients have long-lasting health impairments and rely heavily on family support during and after hospital discharge, surprisingly little is known about the experience of family members (Mirabel et al 2011, Hodgson et al 2012, Chen et al 2016, Tramm et al 2016. The only study to date to explore this issue in a cohort of patients treated for adult respiratory distress syndrome (ARDS) was conducted in 2012 (Harris-Fox 2012).…”

Section: Introductionmentioning

confidence: 99%

Experience and needs of family members of patients treated with extracorporeal membrane oxygenation

Tramm

Ilić

Murphy

et al. 2017

Journal of Clinical Nursing

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Problems and health needs of adult extracorporeal membrane oxygenation patients following hospital discharge: A qualitative study

Cited by 23 publications

References 21 publications

Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study

Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study

The need for extracorporeal membrane oxygenation in adults undergoing congenital heart surgery: Impact and trends of utilization

Experience and needs of family members of patients treated with extracorporeal membrane oxygenation

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