School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
PLoS One. 2018 May 10;13(5):e0196778. doi: 10.1371/journal.pone.0196778. eCollection 2018.
Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients' survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study's aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period.
A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants' QOL at 12 months after discharge was compared with the general population.
A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores.
This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.
体外生命支持（ECLS）为呼吸或心脏衰竭的患者提供紧急肺和心脏辅助。大多数研究都基于患者的存活率来评估 ECLS 的成功。然而，健康状况和生活质量（QOL）的轨迹也应该是重要的考虑因素。本研究旨在探讨在接受 ECLS 并在一年期间出院的成年患者中，健康状况和 QOL 的变化。
这是一项从 2012 年 4 月至 2014 年 9 月进行的前瞻性纵向研究。对出院后一年进行随访的接受 ECLS 的患者进行了方便样本调查。使用身体活动量表、流行病学研究抑郁量表和社会支持量表来测量健康状况；我们使用 Short-Form 36 健康调查的身心成分综合量表来评估生活质量。使用广义估计方程分析抑郁、社会支持、身体活动和 QOL 变化，间隔 3 个月进行一次；比较参与者出院后 12 个月的 QOL 与一般人群。
研究期间共有 231 名患者接受了 ECLS。65 名患者存活至出院（28%的存活率）；32 名参与者完成了研究。数据显示，身体活动评分随时间显著增加（p <.001），而抑郁和社会支持评分显著下降（p <.05 和 p <.001）。接受静脉-静脉 ECLS 的患者的抑郁评分高于接受静脉-动脉 ECLS 的患者（p <.05）。在出院后 9 个月和 12 个月时，PCS 评分显著升高（p <.05 和 p <.001）。MCS 评分无显著变化。
这是一项对接受 ECLS 治疗并在一年期间出院的患者进行的初步研究。在出院一年后，ECLS 的幸存者继续经历身体并发症，一些人仍有抑郁症状；出院后社会支持水平显著下降。医疗保健专业人员应该了解出院后健康状况和 QOL 的轨迹，这有助于制定基于证据的干预措施，并提高 ECLS 幸存者的生活质量。
