Sylvestre Aude, Adda Mélanie, Maltese François, Lannelongue Ariane, Daviet Florence, Parzy Gabriel, Coiffard Benjamin, Roch Antoine, Loundou Anderson, Baumstarck Karine, Papazian Laurent
Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Chemin des Bourrely, 13015, Marseille, France.
Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Faculté de médecine, Aix-Marseille Université, 13005, Marseille, France.
Ann Intensive Care. 2019 Jul 16;9(1):82. doi: 10.1186/s13613-019-0556-1.
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with a significant morbidity. There is the need to investigate long-term cognitive outcome among ARDS survivors treated with VV-ECMO. We aimed to compare the prevalence of long-term cognitive dysfunction and neuropsychological impairment using a highly specific test in severe ARDS survivors treated or not treated with VV-ECMO.
Severe ARDS survivors treated between 2011 and 2017 in an ECMO Regional Referral Center were prospectively evaluated 2 years after their ICU discharge. Patients underwent an in-person interview and examination. The primary outcome was cognitive function, assessed by the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). Secondary outcomes included anxiety, depression, post-traumatic stress disorder (PTSD) and quality-of-life.
We investigated 40 consecutive patients surviving from severe ARDS treated (N = 22) or not (N = 18) with VV-ECMO at a median [interquartile range] of 20 [17-22] and 22 [18-23] months after ICU discharge, respectively. Regarding the main outcome, cognitive function was below normal ranges in 12 (55%) ECMO patients and 10 (56%) non-ECMO patients (p = 0.95). Eight (36%) ECMO patients had moderate-to-severe depressive symptoms as compared with 7 (39%) non-ECMO patients (p = 0.87). Twelve (55%) ECMO patients and eight (44%) non-ECMO patients had moderate-to-severe anxiety symptoms (p = 0.53). Seven (33%) ECMO patients and eight (44%) non-ECMO patients presented a PTSD (p = 0.48). Health-related quality of life did not differ between the two groups.
Using the WAIS-IV, VV-ECMO treatment does not appear to worsen long-term cognitive and neuropsychological outcomes in severe ARDS patients.
静脉-静脉体外膜肺氧合（VV-ECMO）与显著的发病率相关。有必要调查接受VV-ECMO治疗的急性呼吸窘迫综合征（ARDS）幸存者的长期认知结局。我们旨在使用一项高度特异的测试，比较接受或未接受VV-ECMO治疗的重症ARDS幸存者中，长期认知功能障碍和神经心理损害的患病率。
对2011年至2017年期间在一个ECMO区域转诊中心接受治疗的重症ARDS幸存者，在其重症监护病房（ICU）出院2年后进行前瞻性评估。患者接受了面对面访谈和检查。主要结局是认知功能，通过韦氏成人智力量表第4版（WAIS-IV）进行评估。次要结局包括焦虑、抑郁、创伤后应激障碍（PTSD）和生活质量。
我们调查了40例连续的重症ARDS幸存者，其中接受VV-ECMO治疗的患者（N = 22）和未接受治疗的患者（N = 18）在ICU出院后的中位时间[四分位间距]分别为20[17 - 22]个月和22[18 - 23]个月。关于主要结局，12例（55%）接受ECMO治疗的患者和10例（56%）未接受ECMO治疗的患者的认知功能低于正常范围（p = 0.95）。8例（36%）接受ECMO治疗的患者有中度至重度抑郁症状，而未接受ECMO治疗的患者有7例（39%）（p = 0.87）。12例（55%）接受ECMO治疗的患者和八例（44%）未接受ECMO治疗的患者有中度至重度焦虑症状（p = 0.53）。7例（33%）接受ECMO治疗的患者和8例（44%）未接受ECMO治疗的患者存在创伤后应激障碍（p = 约0.48）。两组之间与健康相关的生活质量没有差异。
使用WAIS-IV评估，VV-ECMO治疗似乎不会使重症ARDS患者的长期认知和神经心理结局恶化。
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