Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, Rochester, NY.
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Crit Care Med. 2020 Oct;48(10):e959-e970. doi: 10.1097/CCM.0000000000004488.
To perform a scoping literature review of cognitive, psychiatric, and quality of life outcomes in adults undergoing extracorporeal membrane oxygenation for any indication.
We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO from inception to June 2019.
Observational studies, clinical trials, qualitative studies, and case series with at least 10 adult subjects were included for analysis. Outcomes of interest consisted of general or domain-specific cognition, psychiatric illness, and quality of life measures that included both mental and physical health.
Study selection, data quality assessment, and interpretation of results were performed by two independent investigators in accordance with the PRISMA statement.
Twenty-two articles were included in this review. Six described cognitive outcomes, 12 described psychiatric outcomes of which two were qualitative studies, and 16 described quality of life outcomes. Cognitive impairment was detected in varying degrees in every study that measured it. Three studies examined neuroimaging results and found neurologic injury to be more frequent in venoarterial versus venovenous extracorporeal membrane oxygenation, but described a variable correlation with cognitive impairment. Rates of depression, anxiety, and post-traumatic stress disorder were similar to other critically ill populations and were related to physical disability after extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survivors' physical quality of life was worse than population norms but tended to improve with time, while mental quality of life did not differ significantly from the general population. Most studies did not include matched controls and instead compared outcomes to previously published values.
Extracorporeal membrane oxygenation survivors experience cognitive impairment, psychiatric morbidity, and worse quality of life compared with the general population and similar to other survivors of critical illness. Physical disability in extracorporeal membrane oxygenation patients plays a significant role in psychiatric morbidity. However, it remains unclear if structural brain injury plays a role in these outcomes and whether extracorporeal membrane oxygenation causes secondary brain injury.
对所有适应证接受体外膜肺氧合治疗的成人的认知、精神和生活质量结果进行范围界定文献回顾。
我们检索了 PubMed、EMBASE、Cochrane 图书馆、Web of Science、CINAHL 和 PsycINFO，检索时间从建库至 2019 年 6 月。
纳入了至少 10 例成人患者的观察性研究、临床试验、定性研究和病例系列研究进行分析。感兴趣的结局包括一般或特定领域的认知、精神疾病以及包括心理健康和身体健康在内的生活质量测量。
两名独立研究人员按照 PRISMA 声明进行研究选择、数据质量评估和结果解释。
本综述纳入了 22 篇文章。其中 6 篇描述了认知结局，12 篇描述了精神结局，其中 2 篇为定性研究，16 篇描述了生活质量结局。所有测量认知的研究都发现了不同程度的认知障碍。有 3 项研究检查了神经影像学结果，发现静脉-动脉体外膜肺氧合比静脉-静脉体外膜肺氧合更频繁地发生神经损伤，但描述了与认知障碍的可变相关性。抑郁、焦虑和创伤后应激障碍的发生率与其他危重病患者相似，与体外膜肺氧合后身体残疾有关。体外膜肺氧合幸存者的身体生活质量比人群正常值差，但随着时间的推移往往会改善，而心理健康质量与一般人群无显著差异。大多数研究没有包括匹配的对照组，而是将结果与之前发表的数值进行比较。
与一般人群和其他危重病幸存者相比，体外膜肺氧合幸存者经历认知障碍、精神疾病和较差的生活质量。体外膜肺氧合患者的身体残疾在精神疾病发病中起着重要作用。然而，目前尚不清楚结构性脑损伤是否在这些结局中起作用，以及体外膜肺氧合是否会导致继发性脑损伤。
