Michael D McDonald1, Danielle K Sandsmark2, Jessica A Palakshappa3, Mark E Mikkelsen4, Brian J Anderson4, Jacob T Gutsche5. 1. Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA. 2. Division of Neurocritical Care, Departments of Neurology, Department of Anesthesiology and Critical Care, and Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA. 3. Department of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC. 4. Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA. 5. Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA. Electronic address: Jacob.Gutsche@uphs.upenn.edu.
Abstract
OBJECTIVE: This study aims to determine the prevalence of functional and psychological impairment in survivors of extracorporeal life support (ECLS) and assess the needs of survivors to guide development of an effective follow-up program. DESIGN: This mixed-methods outcomes study used quantitative assessment via standardized instruments (Katz Index of Independence of Activities of Daily Living [Katz ADL], the Lawton Instrumental Activities of Daily Living [Lawton IADL], Hospital Anxiety and Depression Scale, and the Post Traumatic Growth Inventory) and qualitative interview to identify challenges experienced by survivors. SETTING: A single institutional experience in an academic medical center in the United States. PATIENTS: Patient selection targeted patients who underwent veno-venous ECLS for acute respiratory failure between January 1, 2015, and April 1, 2017. Forty-two patients (21 male, 21 female; median age of 49 years; interquartile range 36-57 years) completed the interview a median of 14.6 (interquartile range 7.7-21.1) months after ECLS decannulation. INTERVENTIONS: This was an observational follow-up study for which no intervention was made. MEASUREMENTS AND MAIN RESULTS: The Katz ADL and Lawton IADL revealed high independence and functionality in 62% of patients (26 of 42). Clinically significant anxiety was present in 48% (20 of 42) of patients and depression in 26% (11 of 42). There was a correlation between the number of ADL and IADL deficiencies and depression (rho 0.61, p < 0.001) and anxiety (rho 0.29, p = 0.033) subscales of the Hospital Anxiety and Depression Scale. High levels of posttraumatic growth were noted in 50% (21 of 42) of patients. Nearly all survivors noted that a clinic designed for post-ECLS follow-up would be beneficial. Patients desired access to education, improved coordination of care, and additional mental health resources. CONCLUSIONS: This study demonstrated persistent physical and psychological impairments in survivors of ECLS. Patients consistently expressed a desire to debrief on their hospital course and receive education on possible long-term effects. Study findings suggest that structured follow-up may allow for early identification of psychological and physical impairments to improve outcomes. Future studies should focus on investigating the effect of rehabilitation and follow-up clinics in preventing these issues.
OBJECTIVE: This study aims to determine the prevalence of functional and psychological impairment in survivors of extracorporeal life support (ECLS) and assess the needs of survivors to guide development of an effective follow-up program. DESIGN: This mixed-methods outcomes study used quantitative assessment via standardized instruments (Katz Index of Independence of Activities of Daily Living [Katz ADL], the Lawton Instrumental Activities of Daily Living [Lawton IADL], Hospital Anxiety and Depression Scale, and the Post Traumatic Growth Inventory) and qualitative interview to identify challenges experienced by survivors. SETTING: A single institutional experience in an academic medical center in the United States. PATIENTS: Patient selection targeted patients who underwent veno-venous ECLS for acute respiratory failure between January 1, 2015, and April 1, 2017. Forty-two patients (21 male, 21 female; median age of 49 years; interquartile range 36-57 years) completed the interview a median of 14.6 (interquartile range 7.7-21.1) months after ECLS decannulation. INTERVENTIONS: This was an observational follow-up study for which no intervention was made. MEASUREMENTS AND MAIN RESULTS: The Katz ADL and Lawton IADL revealed high independence and functionality in 62% of patients (26 of 42). Clinically significant anxiety was present in 48% (20 of 42) of patients and depression in 26% (11 of 42). There was a correlation between the number of ADL and IADL deficiencies and depression (rho 0.61, p < 0.001) and anxiety (rho 0.29, p = 0.033) subscales of the Hospital Anxiety and Depression Scale. High levels of posttraumatic growth were noted in 50% (21 of 42) of patients. Nearly all survivors noted that a clinic designed for post-ECLS follow-up would be beneficial. Patients desired access to education, improved coordination of care, and additional mental health resources. CONCLUSIONS: This study demonstrated persistent physical and psychological impairments in survivors of ECLS. Patients consistently expressed a desire to debrief on their hospital course and receive education on possible long-term effects. Study findings suggest that structured follow-up may allow for early identification of psychological and physical impairments to improve outcomes. Future studies should focus on investigating the effect of rehabilitation and follow-up clinics in preventing these issues.
Authors: Shannon M Fernando; Danial Qureshi; Peter Tanuseputro; Eddy Fan; Laveena Munshi; Bram Rochwerg; Robert Talarico; Damon C Scales; Daniel Brodie; Sonny Dhanani; Anne-Marie Guerguerian; Sam D Shemie; Kednapa Thavorn; Kwadwo Kyeremanteng Journal: Intensive Care Med Date: 2019-09-16 Impact factor: 17.440
Authors: Frédéric Sangla; David Legouis; Pierre-Emmanuel Marti; Sebastian D Sgardello; Amélie Brebion; Pierre Saint-Sardos; Mireille Adda; Alexandre Lautrette; Bruno Pereira; Bertrand Souweine Journal: PLoS One Date: 2020-12-14 Impact factor: 3.240
Authors: Eliotte L Hirshberg; Jorie Butler; Morgan Francis; Francis A Davis; Doriena Lee; Fahina Tavake-Pasi; Edwin Napia; Jeanette Villalta; Valentine Mukundente; Heather Coulter; Louisa Stark; Sarah J Beesley; James F Orme; Samuel M Brown; Ramona O Hopkins Journal: BMJ Open Date: 2020-04-06 Impact factor: 2.692