Download Self-reported mental status and quality of life after ECMO treatment

Self-reported mental status and quality of life after ECMO treatment in
Stockholm – a preliminary report
von Bahr, V1, Palmér, K2
1. Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care
Medicine, Karolinska Institutet, Stockholm, Sweden
2. ECMO Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
Introduction/Aim:
ECMO treatment is used in patients with severe cardiac or respiratory failure unresponsive to
conventional treatment methods. Several risk factors for long-term morbidity exist in these
patients, but have not been widely investigated. This study is a preliminary report from an
ongoing Ph D project aimed at investigating the prevalence of long-term sequelae in ECMO
treated patients.
Methods:
62 consecutive adult long-term survivors treated at our center were contacted 5-17 years after
discharge, of which 34 patients agreed to participate during a day at the hospital. Patients were
interviewed and examined, and the Short Form 36 (SF-36), Hospital Anxiety and Depression
Scale (HADS) and Trauma Screening Questionnaire (TSQ) health surveys were administered.
Results:
The majority of patients were at low risk of depression and posttraumatic stress disorder
(<15%), while 24% reported symptoms associated with anxiety. As expected, quality of life was
reduced in ECMO treated patients in most domains; mental quality of life was however
sustained at normal levels.
Conclusion:
Despite severe illness, many patients report acceptable quality of life many years after ECMO
treatment. Further studies with less selection bias are however needed before any conclusions
can be drawn.
Table – Background data and results from self-evaluation tests (n=34)
Background data
Sex, male
Percent
Time to follow-up (years after treatment)
59% (20/34)
Age (years)
Median (IQR)
Range
Median (IQR)
10 (7-15)
5-17
38 (23-52)
Respiratory indication for ECMOa
VV cannulation
VA cannulation
Converted VV-VA
Non-respiratory indication for ECMOb
VV cannulation
VA cannulation
P/F ratio before ECMO treatment
Percent
n
n
n
Percent
n
n
Median (IQR)
94% (32/34)
23
7
2
6% (2/34)
1
1
54 (47-60)
ECMO treatment duration (days)
Median (IQR)
10 (5-16)
Percent
Percent
12% (4/34)
88% (30/34)
Percent
Percent
Percent
Percent
Percent
Percent
12% (4/34)
12% (4/34)
76% (26/34)
3% (1/34)
9% (3/34)
88% (30/34)
ECMO treated patients
78
68
75
64
61
82
79
77
Normal populationc
88
84
75
76
69
89
86
81
45
63
50
50
Trauma Screening Questionnaire
PTSD likely
PTSD not likely
Hospital Anxiety and Depression Scale
Anxiety likely
Anxiety borderline
Anxiety low risk
Depression likely
Depression borderline
Depression low risk
Mean SF-36 scorec
Domain
Physical functioning
Role, physical
Bodily pain
General health
Vitality
Social functioning
Role, emotional
Mental health
Physical Component Summary
Mental Component Summary
IQR: interquartile range
VV: venovenous
VA: venoarterial
P/F ratio: ratio of oxygen partial pressure in arterial blood to inspired oxygen fraction. Data was missing on 7 patients (21%)
PTSD: posttraumatic stress disorder
HADS= Hospital Anxiety and Depression Scale (abnormal, borderline abnormal or normal response)
TSQ= Trauma screening questionnaire (likely or not likely)
a: Indications for respiratory ECMO were: bacterial pneumonia (25), viral pneumonia (1), aspiration (2), lung bleed (1), ARDS
trauma/postoperative (2), non-pulmonary infection (1)
b: Indications for non-respiratory ECMO were: ECPR (1), drowning/warming (1).
c: From the IQOLA SF-36 Standard Swedish Version 1.0. 0% in a domain represents the poorest possible QoL and 100% indicates
full QoL (the best possible result).