ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2019 September;85(9):971-80

DOI: 10.23736/S0375-9393.19.13095-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Long-term functional and psychological recovery in a population of acute respiratory distress syndrome patients treated with VV-ECMO and in their caregivers

Filippo SANFILIPPO ¹ ✉, Mariachiara IPPOLITO ², Cristina SANTONOCITO ¹, Gennaro MARTUCCI ¹, Tiziana CAROLLO ¹, Alessandro BERTANI ³, Patrizio VITULO ³, Michele PILATO ³, Giovanna PANARELLO ¹, Antonino GIARRATANO ², Antonio ARCADIPANE ¹

¹ Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy; ² Section of Anesthesia Analgesia Intensive Care and Emergency, Department of Biopathology and Medical Biotechnologies (DIBIMED), P. Giaccone Polyclinic, University of Palermo, Palermo, Italy; ³ Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy

BACKGROUND: Acute respiratory distress syndrome (ARDS) survivors are affected with long-term physical/mental impairments, with improvements limited mostly to the first year after intensive care (ICU) discharge. Furthermore, caregivers of ICU patients exhibit psychological problems after family-member recovery. We evaluated the long-term physical and mental recovery of ARDS survivors treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), and the long-term psychological impact on their caregivers.
METHODS: Single-center prospective evaluation of a retrospective cohort of 75 ARDS patients treated with VV-ECMO during a seven-year period (25.10.2009-11.08.2016). Primary outcomes were the 36-Item Short-Form Health-Survey (SF-36, patients only), and risks of depression, anxiety or post-traumatic stress disorder (PTSD), both for patients and their caregivers. We investigated correlations between outcomes and population characteristics.
RESULTS: Of 50 ICU-survivors, seven died later and five were not contactable. Among 38 living patients, 33 participated (87%, 31 with their caregiver) with 2.7 years of median follow-up. Physical and mental SF-36 component scores were 42 (inter-quartile range, IQR:22) and 52 (IQR:18.5), respectively. The worst domains of the SF-36 were physical-role limitations (25, IQR:100) and general-health perception (56, IQR:42.5). Psychological tests highlighted high risk of depression (39-42%, patients; 39-52%, caregivers), anxiety (42%, patients; 39%, caregivers), and PTSD (47%, patients; 61%, caregivers). Patient depression or anxiety scores were correlated to age and to the outcome reported by caregivers.
CONCLUSIONS: At almost three-year follow-up, ARDS survivors treated with VV-ECMO showed reduced health-related quality-of-life and high risk of psychological impairment, in particular PTSD. Caregivers of this population were at high psychological risk as well.

KEY WORDS: Patient health questionnaire; Critical care; Quality of life