Anxiety, depression symptoms persist at 1 year among COVID-19 ECMO survivors
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Patients treated with extracorporeal membrane oxygenation for COVID-19 acute respiratory disease had poorer physical and mental health 1 year later, according to study results.
“Despite the partial recovery of lung function tests at 2 year[s], the physical and psychological function of patients supported by ECMO for severe acute respiratory distress syndrome during the first surge of the pandemic is still impaired, with consequences on their quality of life,” Juliette Chommeloux, MD, of the medical ICU of Assistance Publique-Hôpitaux de Paris and at Pitié–Salpêtrière Hospital, and colleagues wrote.
In a multicenter, prospective study published in American Journal of Respiratory and Critical Care Medicine, Chommeloux and colleagues evaluated 62 patients (median age, 47 years; 72% men) from seven ICUs in France who received ECMO for COVID-19 ARDS from March to June 2020 to measure their physical and mental health 6 months and 1 year after starting ECMO.
For physical health, researchers conducted physical examinations and pulmonary function tests, and for mental health, they looked at anxiety, depression, PTSD and quality of life scores against scales and questionnaires.
Of the total cohort, the average time spent on ECMO was 18 days (interquartile range [IQR], 11-25 days), and average time spent on invasive mechanical ventilation was 36 days (IQR, 27-62 days).
Only 20% of patients returned to work at 6 months and 38% returned at 1 year. Additionally, only 31% of patients had a sex drive comparable to before they got COVID-19 at 1 year.
Researchers observed “almost normal” lung function tests, including FVC, FEV and FEV/FVC, at 6 months, but persistently impaired diffusing capacity of the lungs for carbon monoxide (DLCO) from 6 to 12 months.
One year after ECMO onset, 5% of patients had an obstructive syndrome, 21% had a restrictive syndrome (FEV/FVC < 70%) and 58% had DLCO less than 80%.
Using the St. George Respiratory Questionnaire (SGRQ), researchers found no significant improvements in respiratory-related quality of life by 1 year, nor did they find any differences when comparing their cohort with a previously published cohort of patients with non-COVID ARDS treated with ECMO (n = 67).
SGRQ symptoms, including dyspnea and cough, appeared inversely correlated with total lung capacity and FEV at 1 year after discharge (P < .001 for both).
Using the Hospital Anxiety and Depression Scale, 44% of patients displayed symptoms of anxiety and 42% displayed symptoms of depression at 1 year, which appeared comparable to the group of non-COVID ARDS ECMO patients.
At 1 year, researchers found a risk for PTSD among 42% of patients according to the DSM-5 Post-Traumatic Stress Disorder Checklist, which was significantly greater than that observed for patients with non-COVID ARDS treated with ECMO (P = .04).
Lastly, researchers assessed quality of life through the French version of the 36-Item Short-Form Health Survey questionnaire. Results showed severe impairment in mental domains of mental health, role-emotional and role-physical for patients in this cohort compared with the non-COVID ARDS ECMO patients as well as another previously published cohort of patients with COVID ARDS who did not receive ECMO (n = 114).
“Based on the comparison with long-term follow-up of patients without COVID-19 receiving ECMO, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation,” Chommeloux and colleagues wrote. “A personalized, multidisciplinary and prolonged follow-up after hospital discharge of future patients with COVID-19 and their families is needed to further improve their outcomes. Future trials should also evaluate the long-term outcomes of patients who needed ECMO at later phases of the pandemic, when potentially more severe SARS-CoV-2 variants were responsible for severe ARDS.”
This study shows the importance of tracking and describing multidimensional morbidity outcomes over 1 year or longer to better inform patients in the ICU and their families, Laura Dragoi, MD, MHSc, and Margaret S. Herridge, MSc, MD, MPH, of the interdepartmental division of critical care at University of Toronto, wrote in an accompanying editorial.
“Prioritizing long-term outcomes after critical illness creates opportunity for advocacy,” Dragoi and Herridge wrote. “Without fulsome knowledge of 1-year multidimensional sequelae for patients and families after severe lung injury requiring ECMO, we limit opportunities for education, prognostication, initial and ongoing informed consent to ECMO, evolution in ICU practice, mitigation of care transitions, focused multidisciplinary rehabilitation, targeted mental health interventions, barriers to community reintegration, return to work and health policy. The marriage of a detailed ICU data set with 1-year outcomes facilitates the identification of early modifiable risk factors and possible mitigation of long-term disability.”