Psychologic Effects Common in Patients 1 Year After ECMO for COVID-19 ARDS

Half of patients who received venovenous (VV) extracorporeal membrane oxygenation (ECMO) for severe COVID-19-related acute respiratory distress syndrome (ARDS) reported long-term psychological and emotional sequelae, despite partial lung function recovery. However, it is uncertain whether these sequelae were related to the after effects of ECMO or COVID-19. These were among study findings published in the American Journal of Respiratory and Critical Care Medicine.

A multi-center, prospective study was conducted over 14 months in 7 intensive care units (ICUs) in France to determine the long-terms effects of VV-ECMO in patients with COVID-19-related ARDS. Investigators evaluated demographic and physiologic data, pulmonary function tests (PFT) findings, hospital and physical exam data, and quality-of-life (QoL) assessment data at 6 months and at 12 months following onset of ECMO.

In the initial COVID-19 surge in France (between March and June 2020), a total of 132 patients were treated with ECMO in the 7 participating ICUs. Overall, 39% (52 of 132) of the patients died during their hospitalization. Among the 80 individuals who were discharged alive from the hospital, 78% (62 of 80) of them agreed to participate in  long-term follow-up at 6 months and at 12 months following onset of ECMO. Physical examination, PFTs, depression, anxiety, posttraumatic stress disorder (PTSD), and QoL were assessed.

Among the 62 participants, the duration of ECMO and invasive mechanical ventilation were 18 days (range, 11 to 25 days) and 36 days (range, 27 to 62 days), respectively. At 6 months, 2 patients were still hospitalized in an acute rehabilitation center, with only
1 remaining in the facility at 1 year. At 6 months and 12 months, 20% and 38% of the participants, respectively, had returned to their initial work. Further, at 12 months, only 31% of participants had recovered a normal sex drive.

PFTs were nearly normal at 6 months, except for diffusing capacity of carbon monoxide, which still showed impairment at 1 year. Compared with patients without COVID-19 undergoing ECMO, participants with ARDS-related COVID-19 treated with ECMO reported that mental, emotional, and physical health were their most impaired domains. At 1 year following ICU admission, 44% of study participants experienced significant anxiety, 42% reported symptoms of depression, and 42% were at risk for PTSD.

Limitations of this study include: a small patient sample limited to 7 French ICUs; pandemic-related and other difficulties in performing patient follow up; and missing pulmonary assessment data for some of the patients.  

In summary, said study authors, “Despite the partial recovery of the lung function tests at one year, the physical and psychological function of 62 patients supported by ECMO for severe ARDS during the first surge of the pandemic was still impaired with consequences on their quality of life.” However, the authors further stressed that their findings of “poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.