Psychosocial outcome of COVID-19 patients requiring ventilation after ECMO versus long-term mechanical ventilation

Severe COVID-19 frequently necessitates prolonged intensive care treatment, including long-term mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). While survival outcomes of these modalities have been extensively studied, data on long-term psychological sequelae remain limited. This study compared psychosocial outcomes in COVID-19 ICU survivors treated with ECMO vs. prolonged MV alone.

In this exploratory single-centre study combined retrospective clinical data with prospective long-term psychosocial follow-up, 150 adult patients with severe COVID-19 treated between March 2020 and December 2021 were included (ECMO: n = 98; MV: n = 52). Clinical data were collected retrospectively. The primary outcome of the study was long-term psychosocial outcome, which was assessed prospectively using validated questionnaires for depression, post-traumatic stress symptoms, attachment-related anxiety and avoidance, and health-related quality of life during structured long-term follow-up after ICU discharge.

ECMO patients were significantly younger (mean 53.8 vs. 66.0 years; p < 0.001) and required longer invasive ventilation (29.3 vs. 13.3 days; p = 0.011). Among survivors completing long-term follow-up, substantial psychological morbidity was observed in both treatment groups, with differences in attachment-related anxiety and numerically higher depressive and post-traumatic stress symptoms depending on ventilation strategy. Multivariate Cox regression identified older age, chronic obstructive pulmonary disease, and the need for hemodialysis as independent predictors of mortality A total of 29 survivors (ECMO: n = 16; MV: n = 13) completed psychological follow-up assessments. The observed pattern of higher depressive and trauma-related symptom burden among ECMO survivors may reflect the cumulative psychological impact of prolonged life-support, high perceived threat to life, and prolonged dependency during critical illness rather than a direct effect of ECMO itself. Survival did not differ significantly between groups.

Survivors of severe COVID-19 requiring either ECMO or prolonged mechanical ventilation exhibit a substantial long-term psychological burden. Distinct psychosocial profiles were observed between treatment modalities, with higher attachment-related anxiety among MV survivors and numerically greater depressive and trauma-related symptoms among ECMO survivors. These findings highlight the importance of systematic post-ICU psychological screening and the integration of psychosocial outcomes into long-term critical care follow-up.