Patients with severely ill COVID-19 treated with extracorporeal membrane oxygenation (ECMO) had similar survival to hospital discharge and long-term outcomes than survivors treated with mechanical ventilation only, suggest the results of a new multicenter study.
Importantly, the study also showed that survivors, regardless of the treatment they received, experienced significant deficits after their stay in the intensive care unit and suffered from physical, psychological, and cognitive functioning problems for months afterward. .
At 3 months after discharge, 50% of survivors reported cognitive dysfunction, acquired weakness in the ICU, and depression, anxiety o Post traumatic stress disorder; more than 25% still needed supplemental oxygen; and only 1 in 6 survivors returned to work.
The results were presented April 30 to the American Thoracic Surgery Association (AATS) annual meeting.
The study represents the effort of a multidisciplinary team that included cardiothoracic surgeons, critical care physicians, medical staff in long-term care centers, and physiotherapists, as well as other specialists. The research followed patients from five academic centers: University of Colorado, University of Virginia, University of Kentucky, Johns Hopkins University, and Vanderbilt University.
“We were a multidisciplinary team, a whole variety of people to do real monitoring of the long-term outcomes of patients who have been critically ill with COVID-19 and have survived hospital discharge,” author Lauren J. Taylor, MD, Fellow of the Said School of Medicine, University of Colorado, Aurora, Colorado theheart.org | Cardiology Medscape.
It is currently unclear what happens to these patients once they leave the hospital, he noted. “This is information we didn’t have, but when we followed these patients into these multidisciplinary clinics, there was a high level of physical, emotional, or cognitive dysfunction, even for patients who were well enough to live at home at the time. follow-up, ”Taylor said.
“So if you have someone who lives at home and comes into the clinic, you assume it works pretty well, but when you really test them cognitive and psychological tests and check their physical abilities, you’ll find a high degree of deficit the whole cohort of this study, ”he said.
The study was motivated by a discussion with patients’ relatives about the fundamentals, risks, and benefits of ECMO cannulation in patients with COVID-19 mechanical ventilation deficiency, said the author of the Autonomous University of Medicine Jessica V. Rove, also of the UC School of Medicine. theheart.org | Cardiology Medscape.
“We wanted to find out what the hospital course would be like and what cognitive, physical, or emotional deficits they might experience if they survive,” Rove said.
The researchers compared 262 mechanically ventilated patients with 46 ECMO cannulated patients hospitalized between March and May 2020.
Patients with ECMO were younger and traveled farther, but there were no significant differences in gender, race, or body mass index.
Patients with ECMO were mechanically ventilated for longer (mean 26 days vs. 13 days) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, COVID-19 investigative therapies, blood transfusions, and inotropes.
They also experienced increased bleeding and clotting (Pg <.01).
Despite a more complex course of critical illness, patients treated with ECMO had similar discharge survival and long-term outcomes compared with those treated with mechanical ventilation alone.
The survival rate of patients with ECMO was 69.9% and, for patients with mechanical ventilation, 69.6%.
Of the 215 survivors, 66.5% had a documented follow-up within 3 months of hospital discharge. The majority of survivors (93.9%) lived at home; a small percentage (16.1%) had returned to work or their usual activities and 26.2% continued to use supplemental oxygen.
These rates do not differ significantly depending on the state of ECMO and the rates of physical, psychological, and cognitive deficit do not differ significantly.
“The cognitive, emotional, and physical deficits observed in survivors of severe COVID-19 disease can only be treated if diagnosed,” Rove said.
“Adverse effects can potentially be improved with the use of best practices in the ICU, maximizing acute rehabilitation services where indicated, and follow-up with providers of post-ICU multidisciplinary clinics that can assess and treat these patients for optimize survival, ”he said.
American Association of Thoracic Surgery 101st Annual Meeting Presented April 30, 2021.