Predictors of health-related quality of life in patients undergoing extracorporeal membrane oxygenation for acute severe respiratory failure

Ahmed Mham Mostafa; Christopher J Tuttle; Mikel A Mckie; Jo-Anne Fowles; Jasvir Parmar; Alain Vuylsteke

doi:10.1177/17511437221111639

Predictors of health-related quality of life in patients undergoing extracorporeal membrane oxygenation for acute severe respiratory failure

J Intensive Care Soc. 2023 Aug;24(3):283-291. doi: 10.1177/17511437221111639. Epub 2022 Jun 29.

Authors

Ahmed Mham Mostafa¹, Christopher J Tuttle¹, Mikel A Mckie², Jo-Anne Fowles³, Jasvir Parmar⁴, Alain Vuylsteke³

Affiliations

¹ School of Clinical Medicine, University of Cambridge, Cambridge, UK.
² Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
³ Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
⁴ Department of Transplantation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.

Abstract

Background: 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.

Methods: 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.

Results: 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], p = 0.0005), renal replacement therapy (-0.149, [-0.046; -0.252], p = 0.0044), and having received more than four platelet units (-0.157, [-0.031; -0.283], p = 0.0146) as predictors of poor HRQOL.

Conclusion: 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.

Keywords: Acute severe respiratory failure; adults; extracorporeal membrane oxygenation; health-related quality of life.