Physical and Psychological Outcomes of Intensive Care Survivors Comparing Patients Who Received Venovenous Extracorporeal Membrane Oxygenation With Those Receiving Conventional Ventilation for a Minimum of 3 Days

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Background Adult patients receiving extracorporeal membrane oxygenation (ECMO) for acute respiratory failure generally are younger and have fewer comorbidities before ICU admission than other critically ill patients. These factors might be associated with less morbidity after hospital discharge. However, few studies have compared patient-reported outcomes of ECMO survivors with those of the general ICU population. Research Question What are the psychological, health-related quality of life, sleep, swallowing, nutrition, airway, and voice outcomes measured 3 months after hospital discharge, comparing those reported by ICU survivors receiving ECMO with those receiving invasive mechanical ventilation (IMV; ≥ 3 days)? Study Design and Methods In this prospective observational longitudinal cohort (2015-2023), patients attending a post-ICU recovery clinic were recruited, including those admitted to an 11-bed ECMO service. Data included demographic and clinical characteristics and self-reported outcomes. We compared outcomes using linear and logistic regression modelling. Results We received patient-reported outcomes from 841 of 1,848 post-ICU recovery clinic attendees (46%; 54% attended but did not complete questionnaires). Of these, 289 patients (34%) received ECMO, were 13 years younger on average ( P < .001), and more often were White (81% vs 61%; P = .03). Compared with general patients in the ICU, patients receiving ECMO showed similar admission illness severity (median Acute Physiology and Chronic Health Evaluation [APACHE] II score of 16 in both groups), but a longer IMV duration (median, 15 days [interquartile range (IQR), 10-25 days] vs 8 days [IQR, 4-16 days]; P < .001) and higher delirium prevalence (75% vs 54%; P < .001). We found no difference in psychological morbidity prevalence and no association of ECMO with suspected posttraumatic stress disorder (adjusted OR, 0.86; 95% CI, 0.59-1.24), controlling for age, sex, and APACHE II score. Fewer patients receiving ECMO had mobility issues (EuroQol 5-Dimension 5-Level questionnaire [EQ-5D-5L] mobility, 29% vs 47%; P < .001). We found no differences in other physical morbidity outcomes and no association of ECMO with EQ-5D-5L visual analog scale score (adjusted estimate, 2.4; 95% CI, –3.9 to 10.8). Interpretation Our results show that except for better mobility, patients who received ECMO achieved similar outcomes after hospital discharge as patients requiring IMV for a minimum of 3 days.

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