Functional recovery in a cohort of ECMO and non-ECMO acute respiratory distress syndrome survivors

Authors

Mackenzie Snyder, University of Maryland School of Medicine, Baltimore, MD, USA.
Binta Y. Njie, University of Maryland School of Medicine, Baltimore, MD, USA.
Ilana Grabenstein, University of Maryland School of Medicine, Baltimore, MD, USA.
Sara Viola, Department of Medicine, Division of Critical Care Medicine, University of Maryland Baltimore Washington Medical Center, Baltimore, MD, USA.
Hatoon Abbas, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA.
Waqas Bhatti, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA.
Ryan Lee, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA.
Rosalie Traficante, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA.
Siu Yan Yeung, Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA.
Jonathan H. Chow, Department of Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine, Washington, DC, USA.
Ali Tabatabai, Department of Medicine, Division of Education, University of Maryland School of Medicine, Baltimore, MD, USA.
Bradley S. Taylor, Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Siamak Dahi, Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Thomas Scalea, Department of Surgery and Program in Trauma, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Joseph Rabin, Department of Surgery and Program in Trauma, R Adams Crowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Alison Grazioli, Department of Medicine, University of Maryland School of Medicine, Program in Trauma, Baltimore, MD, USA.
Carolyn S. Calfee, Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, CA, USA.
Noel Britton, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Andrea R. Levine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca St, Baltimore, MD, 21231, USA. Andrea.Levine@som.umaryland.edu.

Document Type

Journal Article

Publication Date

11-14-2023

Journal

Critical care (London, England)

Volume

27

Issue

1

DOI

10.1186/s13054-023-04724-y

Keywords

ARDS; COVID-19; ECMO; Functional recovery; Long-term outcomes; Pulmonary function tests

Abstract

BACKGROUND: The mortality benefit of VV-ECMO in ARDS has been extensively studied, but the impact on long-term functional outcomes of survivors is poorly defined. We aimed to assess the association between ECMO and functional outcomes in a contemporaneous cohort of survivors of ARDS. METHODS: Multicenter retrospective cohort study of ARDS survivors who presented to follow-up clinic. The primary outcome was FVC% predicted. Univariate and multivariate regression models were used to evaluate the impact of ECMO on the primary outcome. RESULTS: This study enrolled 110 survivors of ARDS, 34 of whom were managed using ECMO. The ECMO cohort was younger (35 [28, 50] vs. 51 [44, 61] years old, p < 0.01), less likely to have COVID-19 (58% vs. 96%, p < 0.01), more severely ill based on the Sequential Organ Failure Assessment (SOFA) score (7 [5, 9] vs. 4 [3, 6], p < 0.01), dynamic lung compliance (15 mL/cmH0 [11, 20] vs. 27 mL/cmH0 [23, 35], p < 0.01), oxygenation index (26 [22, 33] vs. 9 [6, 11], p < 0.01), and their need for rescue modes of ventilation. ECMO patients had significantly longer lengths of hospitalization (46 [27, 62] vs. 16 [12, 31] days, p < 0.01) ICU stay (29 [19, 43] vs. 10 [5, 17] days, p < 0.01), and duration of mechanical ventilation (24 [14, 42] vs. 10 [7, 17] days, p < 0.01). Functional outcomes were similar in ECMO and non-ECMO patients. ECMO did not predict changes in lung function when adjusting for age, SOFA, COVID-19 status, or length of hospitalization. CONCLUSIONS: There were no significant differences in the FVC% predicted, or other markers of pulmonary, neurocognitive, or psychiatric functional recovery outcomes, when comparing a contemporaneous clinic-based cohort of survivors of ARDS managed with ECMO to those without ECMO.

APA Citation

Snyder, Mackenzie; Njie, Binta Y.; Grabenstein, Ilana; Viola, Sara; Abbas, Hatoon; Bhatti, Waqas; Lee, Ryan; Traficante, Rosalie; Yeung, Siu Yan; Chow, Jonathan H.; Tabatabai, Ali; Taylor, Bradley S.; Dahi, Siamak; Scalea, Thomas; Rabin, Joseph; Grazioli, Alison; Calfee, Carolyn S.; Britton, Noel; and Levine, Andrea R., "Functional recovery in a cohort of ECMO and non-ECMO acute respiratory distress syndrome survivors" (2023). GW Authored Works. Paper 3806.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3806

Department

Anesthesiology and Critical Care Medicine