Mostafa Ahmed Mham, Tuttle Christopher J, Mckie Mikel A, Fowles Jo-Anne, Parmar Jasvir, Vuylsteke Alain
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
J Intensive Care Soc. 2023 Aug;24(3):283-291. doi: 10.1177/17511437221111639. Epub 2022 Jun 29.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a form of life support used in severe respiratory failure. While the short-term complications of VV-ECMO are well described, impacts on health-related quality of life (HRQOL) are less well characterised. This study aims to assess the HRQOL of patients who underwent VV-ECMO for acute severe respiratory failure and explore predictors of poor HRQOL.
We performed a retrospective, observational study of a large cohort of adults who underwent VV-ECMO for acute severe respiratory failure in a single tertiary centre (June 2013-March 2019). Patients surviving critical care discharge were invited to a six-month clinic, where they completed an EQ-5D-5L questionnaire assessing HRQOL. Multivariate analysis was performed to assess prognostic factors for HRQOL.
Among the 245 consecutive patients included in this study (median age 45 years), 187 (76.3%) survived until ECMO decannulation and 172 (70.2%) until hospital discharge. Of those, 98 (57.3%) attended a follow-up clinic at a mean (±SD) of 204 (±45) days post-discharge. Patients reported problems with pain/discomfort (56%), usual daily activities (53%), anxiety/depression (49%), mobility (46%), and personal care (21%). Multivariate analysis identified limb ischaemia (-0.266, 95% C.I. [-0.116; -0.415], = 0.0005), renal replacement therapy (-0.149, [-0.046; -0.252], = 0.0044), and having received more than four platelet units (-0.157, [-0.031; -0.283], = 0.0146) as predictors of poor HRQOL.
We report that survivors of VV-ECMO have reduced HRQOL in multiple domains at 6 months, with pain reported most frequently. Patients who had limb ischaemia, renal replacement therapy or were transfused more than four units of platelets are particularly at risk of poor HRQOL and may benefit from added support measures.
静脉-静脉体外膜肺氧合（VV-ECMO）是用于严重呼吸衰竭的一种生命支持形式。虽然VV-ECMO的短期并发症已有详细描述，但对健康相关生活质量（HRQOL）的影响却鲜为人知。本研究旨在评估因急性严重呼吸衰竭接受VV-ECMO治疗的患者的HRQOL，并探索HRQOL较差的预测因素。
我们对在单个三级中心（2013年6月至2019年3月）因急性严重呼吸衰竭接受VV-ECMO治疗的一大群成年人进行了一项回顾性观察研究。重症监护出院后存活的患者被邀请到六个月的门诊，在那里他们完成了一份评估HRQOL的EQ-5D-5L问卷。进行多变量分析以评估HRQOL的预后因素。
在本研究纳入的245例连续患者（中位年龄45岁）中，187例（76.3%）存活至ECMO拔管，172例（70.2%）存活至出院。其中，98例（57.3%）在出院后平均（±标准差）204（±45）天参加了随访门诊。患者报告了疼痛/不适（56%）、日常活动（53%）、焦虑/抑郁（49%）、活动能力（46%）和个人护理（21%）方面的问题。多变量分析确定肢体缺血（-0.266，95%置信区间[-0.116；-0.415]，P = 0.0005）、肾脏替代治疗（-0.149，[-0.046；-0.252]，P = 0.0044）以及接受超过四个血小板单位（-0.157，[-0.031；-0.283]，P = 0.0146）是HRQOL较差的预测因素。
我们报告，VV-ECMO幸存者在6个月时多个领域的HRQOL降低，疼痛报告最为频繁。有肢体缺血、肾脏替代治疗或输注超过四个单位血小板的患者HRQOL较差的风险尤其高，可能受益于额外的支持措施。
