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Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter
Ary Serpa Neto1,2,3, Alisa M Higgins1, Michael J Bailey1,2
1Australian and New Zealand Intensive Care Research Centre (A.S.N., A.M.H., M.J.B., S.A., B.J.F., N.J.L., A.J.C.B., D.J.C., S.P.M.G., N.O., R.L.P., D.V.P., C.D., T.V.T., A.A.U., C.L.H.), School of Public Health and Preventive Medicine.
Background:
Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.
Methods:
Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation.
Results:
Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% women), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; P=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; P=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; P<0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation.
Conclusions:
At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03793257.
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