Long-term psychological outcomes after extracorporeal membrane oxygenation: A systematic review and meta-analysis

Use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure has increased substantially. While long-term outcomes for psychological health are increasingly assessed and addressed in critical care survivorship research, prevalence and characteristics of adult intensive care survivors receiving ECMO have not been systematically evaluated.

We conducted a pre-registered systematic review and meta-analysis of long-term psychological outcomes following ECMO through May 23, 2025. Animal-only studies, qualitative analyses, case studies, reviews, editorials, and non-English studies were excluded. Quality assessments were completed. Pooled estimates of point prevalence composite scores are reported with meta-regression and sensitivity analyses.

Forty-two studies met inclusion criteria. The pooled prevalence of anxiety across 26 studies (n = 936) was 28% (95% CI: 21-36%; I² = 77.5%), with a mean Hospital Anxiety and Depression Scale (HADS) anxiety - score of 4.67 (95% CI: 3.84-5.50; I² = 78.3%). Depression prevalence across 32 studies (n = 1224) was 21% (95% CI: 16-27%; I² = 64.8%), with a mean HADS depression score of 4.35 (95% CI: 3.56-5.14; I² = 90.0%). Post-traumatic stress disorder prevalence across 30 studies (n = 1128) was 19% (95% CI: 15-23%; I² = 57.1%). Heterogeneity was partially explained by sample size and country of origin.

Adult ECMO survivors experience substantial psychological distress, with prevalence rates exceeding those observed in the general population. These findings support routine psychological screening and integration of mental health care into ECMO survivorship pathways.