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体外膜肺氧合存活是一个纵向过程:探索一种生存模型以改善生活质量。

Surviving Extracorporeal Membrane Oxygenation Is a Longitudinal Process: Exploring a Survivorship Model to Improve Quality of Life.

作者信息

Hasasna Islam, Andrew Bethany, Rothenberg Paul, Platten Michael, Rajjoub Hakam, White Debra, Ganoe Amber, Sappington Penny, McCarthy Paul, Hayanga J W Awori

机构信息

Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.

出版信息

Ann Thorac Surg Short Rep. 2024 Dec 11;3(2):473-478. doi: 10.1016/j.atssr.2024.11.010. eCollection 2025 Jun.

Abstract

BACKGROUND

Venovenous extracorporeal membrane oxygenation is a salvage therapy for patients with acute respiratory distress syndrome. Survivors struggle with daily activities after decannulation and discharge. We evaluated outcomes after implementing a survivorship approach based on a cancer survivorship clinic model to improve quality of life (QoL) and optimize resource consumption.

METHODS

We established a multidisciplinary survivorship clinic using telehealth and in-person physical and occupational therapy teams. Data from the 12-item Short Form Health Survey (SF-12) were collected between 2020 and 2023. Interviews were conducted at 6 months, 1 year, and 2 years after decannulation. The patients were offered in-person and telephone-based counseling with scheduled inpatient and outpatient rehabilitation visits. SF-12 mental component summary (MCS-12) and physical component summary (PCS-12) scores were used to calculate quality-adjusted life years (QALYs). The relationship between QoL, costs, and length of stay outcomes was assessed using generalized linear and mixed models.

RESULTS

Fifty-three patients were monitored for 3 years. Mean age was 41.7 years, 98.1% were White, and 50.9% were men. At 6 months, 1 year, and 2 years, mean MSC-12 scores were 52.9, 50, and 49.7, PCS-12 scores were 43.7, 41.8, and 47.3, and QALYs were 0.837, 0.829, and 0.826, respectively. MCS-12 showed no significant difference from the United States population. PCS-12 was significantly lower than the United States population during the first and second evaluations ( < .001) but showed no difference at 36 months. QALYs were significantly higher ( < .001). Higher resource consumption was associated with lower PCS-12 scores and QALYs.

CONCLUSIONS

The survivorship approach with counseling and rehabilitation yields acceptable QoL, which may inform strategies to improve the cost-effectiveness of venovenous extracorporeal membrane oxygenation.

摘要

背景

静脉-静脉体外膜肺氧合是治疗急性呼吸窘迫综合征患者的一种挽救疗法。幸存者在拔管和出院后进行日常活动时面临困难。我们评估了基于癌症幸存者诊所模式实施的幸存者照护方案对改善生活质量(QoL)和优化资源消耗的效果。

方法

我们利用远程医疗以及现场物理治疗和职业治疗团队建立了一个多学科幸存者诊所。在2020年至2023年期间收集了12项简短健康调查问卷(SF-12)的数据。在拔管后6个月、1年和2年进行访谈。为患者提供现场和电话咨询,并安排住院和门诊康复就诊。使用SF-12精神健康综合评分(MCS-12)和身体健康综合评分(PCS-12)来计算质量调整生命年(QALY)。使用广义线性模型和混合模型评估生活质量、成本和住院时间结果之间的关系。

结果

对53名患者进行了3年的监测。平均年龄为41.7岁,98.1%为白人,50.9%为男性。在6个月、1年和2年时,平均MCS-12评分分别为52.9、50和49.7,PCS-12评分分别为43.7、41.8和47.3,QALY分别为0.837、0.829和0.826。MCS-12与美国人群无显著差异。在第一次和第二次评估期间,PCS-12显著低于美国人群(P<0.001),但在36个月时无差异。QALY显著更高(P<0.001)。更高的资源消耗与更低的PCS-12评分和QALY相关。

结论

采用咨询和康复的幸存者照护方案可带来可接受的生活质量,这可能为提高静脉-静脉体外膜肺氧合成本效益的策略提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/da34/12167524/638db55d1b25/gr1.jpg

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