1
|
Gugushvili A, Jarosz E. A longitudinal study of perceived social position and health-related quality of life. Soc Sci Med 2024; 340:116446. [PMID: 38042026 DOI: 10.1016/j.socscimed.2023.116446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND A large body of evidence suggests that there is a social gradient in the association between perceived social position and various health outcomes. Yet only a fraction of this research uses longitudinal data, and these studies usually rely on two data points in time, consider a single health outcome measure, overlook non-linear effects of perceived social position, and come almost exclusively from the Western welfare democracies. METHODS Using data for 1921 individuals from three waves (2008, 2013, 2018) of the Polish Panel Survey (POLPAN), we fit between- and within-individuals hybrid-effects models with cluster-robust standard errors to investigate the association between one's perceived social position (self-placement on a socioeconomic hierarchy scale varying 1 to 10) and subsequent health-related quality of life (HRQoL) measured using the Nottingham Health Profile (NHP) and its six components. RESULTS We find that the association between perceived social position and health-related quality of life is larger when estimated between individuals than within individuals, yet in fixed- and hybrid-effects models perceived social position remains significantly and negatively linked with both the aggregated NHP measure as well as with its components such as emotional reaction, physical abilities, sleep, and social isolation. We also identify that starting to perceive oneself at the lower end of the social hierarchy is associated with a deteriorating health-related quality of life but a change at the top of the perceived social hierarchy is not linked with an improvement in NHP scores. CONCLUSIONS We provide new evidence on the significant and non-linear links between perceived social position and health-related quality of life and highlight possible pathways linking these two aspects of individuals' lives.
Collapse
Affiliation(s)
- Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Norway.
| | - Ewa Jarosz
- Faculty of Economic Sciences, University of Warsaw, Poland
| |
Collapse
|
2
|
Wang F, Zhang Y, Wu S, Xie H, Lin D, Wen X, Duan Z, Lu Y, Liu Z, Hu S, Liu J. Post-discharge experiences of patients with extracorporeal membrane oxygenation support: A qualitative study. Perfusion 2024; 39:189-200. [PMID: 36282873 DOI: 10.1177/02676591221135165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
PURPOSE To explore the life experiences of patients who have been discharged after undergoing extracorporeal membrane oxygenation (ECMO) support. DESIGN A qualitative descriptive approach was used. METHODS Patients who have undergone ECMO support and have been discharged were recruited. Thirteen participants were involved in this study. The data were collected through a semi-structured interview and analyzed using the Colaizzi method. FINDINGS Four major themes in life experiences were reported by the participants: changes in physical function, changes in psychological state, active adaptation to daily life, and substantial rehabilitation needs. CONCLUSION Different, continuous, and convenient post-discharge physical and mental interventions, social support, spiritual support, and rehabilitation services should be provided according to the patient's circumstances. We also call on the government to increase the patient reimbursement rate for ECMO treatment. These measures may help to improve the quality of life of patients.
Collapse
Affiliation(s)
- FengZhen Wang
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - YuHao Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - ShuJing Wu
- Department of Nursing, Gannan Healthcare Vocational College, Ganzhou City, Jiangxi, China
| | - HongYing Xie
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi, China
| | - DongMei Lin
- School of Nursing, Gannan Medical University, Ganzhou City, Jiangxi, China
| | - XianMing Wen
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - ZhiSheng Duan
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - YuFeng Lu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - ZiYou Liu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Shuo Hu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| | - Jian Liu
- Department of Heart Center, The First Affiliated Hospital of Gannan Medical University, Ganzhou City, Jiangxi, China
| |
Collapse
|
3
|
Yu A, Zhang M, Wang Y, Yan L, Guo C, Deng J, Xiong J. Health-related quality of life assessment instruments for extracorporeal membrane oxygenation survivors: A scoping review. Perfusion 2023:2676591231211518. [PMID: 37934027 DOI: 10.1177/02676591231211518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Extracorporeal membrane oxygenation (ECMO) has been successfully and widely used in adult patients for the past 5 years. About 50% of these patients can survive and are discharged from hospitals. Health-related quality of life (HRQOL) is crucial for evaluating survived ECMO patients. This scoping review aims to identify instruments commonly used to measure HRQOL of ECMO survivors and give pertinent instrument characteristics. METHODS A systematic search was conducted in PubMed, Web of Science, EMBASE (OVID), MEDLINE (OVID), CINAHL (EBSCO), Cochrane Library, and three Chinese databases from January 2012 to December 2021. Two reviewers independently reviewed publication selection and data extraction. RESULTS Twenty-nine studies met the inclusion criteria. Most studies (93%) were cross-sectional, and the median (or average) follow-up time ranged from 3 months to 9 years. Two prospective studies (7%) followed patients longitudinally until 1 year after discharge. ECMO survivors had poorer long-term HRQOL than the general population. However, it is comparable to or better than patients with other critical or chronic illnesses. Identified HRQOL assessment instruments show four generic HRQOL instruments, one disease-specific HRQOL instrument, and nineteen single-dimensional instruments. Seven instruments were used in more than three articles. SF-36 (86.2%), IES/IES-R (41.4%), and HADS (37.9%) were the most frequently used instruments. CONCLUSION The timing, frequency, and tools for HRQOL assessment of ECMO survivors are variable. No ECMO-specific HRQOL instrument was developed and validated. Further studies on assessment instruments are warranted. Research is also needed to identify interventions that may enhance HRQOL in ECMO survivors.
Collapse
Affiliation(s)
- Anqi Yu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Zhang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Wang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yan
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Chunling Guo
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Juan Deng
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jie Xiong
- Department of Intensive Care Unit, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
de Vlugt R, Spek B, van de Pol I, Rigter S. Quality of life after extra corporeal life support therapy. Perfusion 2023; 38:1189-1195. [PMID: 35656759 DOI: 10.1177/02676591221106148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extra Corporeal Life Support (ECLS) may be a life-saving treatment for patients with reversible cardiac and/or respiratory failure. ECLS is associated with a high risk of complications and mortality. Because only a small number of studies have been conducted into the long-term effects of ECLS, we investigated the difference in quality of life, anxiety and depressive complaints and PTSD 3 months after ICU discharge. METHOD It is a retrospective case-control study covering the period January 2012 to December 2017. The ECLS patient group was compared to a matched similar patient group in the Intensive Care (IC) that did not have ECLS therapy. Quality of life was measured with the Short-Form-36 (SF-36) questionnaire, anxiety and depression was measured with the Hospital Anxiety and Depression Scale (HADS) questionnaire and for PTSD the Impact of Events Scale (IES) questionnaire was used, comparing sum scores and cut-off points of scores from both groups. RESULTS Included were 19 patients in the ECLS group and 38 in the control group. The mean sum scores on the sub scales of the SF36 questionnaire were the same for both groups. Only the mean score of 66.2 (scale 0-100) on the domain 'general health experience' was statistically significantly different in the ECLS group than in the control group (56.8, p = .02). There was no significant difference between the sum scores of both groups on anxiety and depressive complaints. In the ECLS group 32% of the patients may have a depressive disorder versus 18% from the control group (p = .32). And 26% of the patients from the ECLS group may have an anxiety disorder versus 7% from the control group (p = .51). The incidence of PTSD was 42% in the ECLS group and 24% in the control group (p = .22). CONCLUSION We found no statistically significant difference in quality of life, anxiety and depressive symptoms and PTSD symptoms between ECLS patients and the matched control group - 3 months after the ICU discharge. The incidence of anxiety and depressive symptoms and PTSD in the ECLS group is higher than in the control group, however, this difference is not significant.
Collapse
Affiliation(s)
- Roos de Vlugt
- Intensive Care, St. Antonius hospital, Nieuwegein, Netherlands
| | - Bea Spek
- Department Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Sander Rigter
- Department of anesthesiology and ICU, St Antonius Ziekenhuis, Nieuwegein, Netherlands
| |
Collapse
|
5
|
Cankar T, Krepek M, Kosmopoulos M, Radšel P, Yannopoulos D, Noc M, Goslar T. Long-Term Survival and Quality of Life in Non-Surgical Adult Patients Supported with Veno-Arterial Extracorporeal Oxygenation. J Clin Med 2022; 11:6452. [PMID: 36362678 PMCID: PMC9658568 DOI: 10.3390/jcm11216452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for hemodynamic support is on the rise. Not much is known about the impact of extracorporeal membrane oxygenation (ECMO) and its complications on long-term survival and quality of life. METHODS In this single-center, cross-sectional study, we evaluated the survival and quality of life in patients treated with VA ECMO between May 2009 and July 2019. Follow-up was conducted between November 2019 and January 2020. RESULTS Overall, 118 patients were evaluated in this study. Of the 37 patients who were alive at hospital discharge, 32 answered the EuroQol-5 dimensional-5-level questionnaire (EQ-5D-5L). For patients discharged alive from the hospital, mean survival was 8.1 years, 8.4 years for cardiogenic shock, and 5.0 years for patients with refractory cardiac arrest. EQ-5D-5L index value of ECMO survivors was not significantly different from the general age-matched population. Neurologic complications and major bleeding during index hospitalization limit long-term quality of life. CONCLUSIONS Patients treated with VA ECMO have high in-hospital mortality, with extracorporeal membrane oxygenation cardio-pulmonary resuscitation patients being at higher risk of early death. However, once discharged from the hospital, most patients remain alive with a reasonable quality of life.
Collapse
Affiliation(s)
- Tomaž Cankar
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mihela Krepek
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine and Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Peter Radšel
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine and Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Marko Noc
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaž Goslar
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| |
Collapse
|
6
|
Karpasiti T. A Narrative Review of Nutrition Therapy in Patients Receiving Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:763-771. [PMID: 34324446 DOI: 10.1097/mat.0000000000001540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in patients with severe cardiorespiratory failure has seen significant growth in the last decade. Despite this, there is paucity of data surrounding the optimum nutritional management for ECMO patients. This review aimed to describe current nutrition practices in patients receiving ECMO, critically appraise available studies and identify areas for future research. A literature search was conducted in PubMed, MEDLINE, and CINAHL Plus to identify all randomized trials and observational studies published between July 2000 and July 2020 investigating nutrition practices in critically ill adults receiving ECMO. The primary outcomes were nutritional adequacy, gastrointestinal complications, and physical function. Secondary outcomes included mortality, length of stay, and duration on ECMO support. From a total of 31 studies identified, 12 met the inclusion criteria. Nine observational studies were reviewed following eligibility assessment. Early enteral nutrition was deemed safe and feasible for ECMO patients; however, meeting nutritional targets was challenging. Utilizing alternative nutrition routes is an option, although risks and benefits should be taken into consideration. Data on gastrointestinal complications and other clinical outcomes were inconsistent, and no data were identified investigating the effects of nutrition on the physical and functional recovery of ECMO patients. Nutrition therapy in ECMO patients should be provided in line with current guidelines for nutrition in critical illness until further data are available. Further prospective, randomized studies investigating optimum nutrition practices and effects on clinical and functional outcomes are urgently required.
Collapse
Affiliation(s)
- Terpsi Karpasiti
- From the Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| |
Collapse
|
7
|
Chen KH, Lee PS, Tsai FC, Weng LC, Yeh SL, Huang HC, Lin SS. Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study. Heart Lung 2021; 52:76-85. [PMID: 34911020 DOI: 10.1016/j.hrtlng.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.
Collapse
Affiliation(s)
- Kang-Hua Chen
- Associate Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Associate Research Fellow, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan.
| | - Pei-Shan Lee
- Surgical Intensive Care Unit, Fu Jen Catholic University Hospital, Taipei, Taiwan
| | - Feng-Chun Tsai
- Associate Professor, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou Branch, Taiwan
| | - Li-Chueh Weng
- Professor, School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Research Fellow, Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Ling Yeh
- Director, Department of Nursing, Chang Gung Memorial Hospital, Tao-Yuan Branch, Taiwan; Adjunct Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Huei-Chiun Huang
- Case Manager, Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Shu-Siang Lin
- Clinical Nursing Teacher, Department of Nursing, Chang Gung University of Science and Technology Taiwan
| |
Collapse
|
8
|
Gray EL, Forrest P, Southwood TJ, Totaro RJ, Plunkett BT, Torzillo PJ. Long-term outcomes of adults with acute respiratory failure treated with veno-venous extracorporeal membrane oxygenation. Anaesth Intensive Care 2021; 49:477-485. [PMID: 34772300 DOI: 10.1177/0310057x211042386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning. A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m2), and mostly were male (59%). Most patients (60%) had no comorbidities. The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1-9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.
Collapse
Affiliation(s)
- Emma L Gray
- Department of Respiratory and Sleep Medicine, 2205Royal Prince Alfred Hospital, Royal Prince Alfred Hospital, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Paul Forrest
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Department of Anaesthetics, 2205Royal Prince Alfred Hospital, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Timothy J Southwood
- Department of Intensive Care Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Richard J Totaro
- Department of Intensive Care Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Brian T Plunkett
- Department of Cardiothoracic Surgery, 2205Royal Prince Alfred Hospital, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Paul J Torzillo
- Department of Respiratory and Sleep Medicine, 2205Royal Prince Alfred Hospital, Royal Prince Alfred Hospital, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Department of Intensive Care Services, Royal Prince Alfred Hospital, Camperdown, Australia
| |
Collapse
|
9
|
Khan IR, Saulle M, Oldham MA, Weber MT, Schifitto G, Lee HB. Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature. Crit Care Med 2021; 48:e959-e970. [PMID: 32886470 DOI: 10.1097/ccm.0000000000004488] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To perform a scoping literature review of cognitive, psychiatric, and quality of life outcomes in adults undergoing extracorporeal membrane oxygenation for any indication. DATA SOURCES We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO from inception to June 2019. STUDY SELECTION Observational studies, clinical trials, qualitative studies, and case series with at least 10 adult subjects were included for analysis. Outcomes of interest consisted of general or domain-specific cognition, psychiatric illness, and quality of life measures that included both mental and physical health. DATA EXTRACTION Study selection, data quality assessment, and interpretation of results were performed by two independent investigators in accordance with the PRISMA statement. DATA SYNTHESIS Twenty-two articles were included in this review. Six described cognitive outcomes, 12 described psychiatric outcomes of which two were qualitative studies, and 16 described quality of life outcomes. Cognitive impairment was detected in varying degrees in every study that measured it. Three studies examined neuroimaging results and found neurologic injury to be more frequent in venoarterial versus venovenous extracorporeal membrane oxygenation, but described a variable correlation with cognitive impairment. Rates of depression, anxiety, and post-traumatic stress disorder were similar to other critically ill populations and were related to physical disability after extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survivors' physical quality of life was worse than population norms but tended to improve with time, while mental quality of life did not differ significantly from the general population. Most studies did not include matched controls and instead compared outcomes to previously published values. CONCLUSIONS Extracorporeal membrane oxygenation survivors experience cognitive impairment, psychiatric morbidity, and worse quality of life compared with the general population and similar to other survivors of critical illness. Physical disability in extracorporeal membrane oxygenation patients plays a significant role in psychiatric morbidity. However, it remains unclear if structural brain injury plays a role in these outcomes and whether extracorporeal membrane oxygenation causes secondary brain injury.
Collapse
Affiliation(s)
- Imad R Khan
- Division of Neurocritical Care, Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Michael Saulle
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Miriam T Weber
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Giovanni Schifitto
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
10
|
Kolle A, Irgens EC, Moi AL, Ottesen ØH, Svendsen ØS, Haaverstad R, Johansen VA. The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross-Sectional Study. Intensive Crit Care Nurs 2021; 65:103058. [PMID: 33867241 DOI: 10.1016/j.iccn.2021.103058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/03/2021] [Accepted: 03/17/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation. DESIGN AND SETTING This is a cross-sectional study. The population were all patients discharged (2008-2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited. MAIN OUTCOME MEASURES Symptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life. RESULTS Symptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function. CONCLUSION Patients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.
Collapse
Affiliation(s)
- Aina Kolle
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
| | - Elsa C Irgens
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind H Ottesen
- Forensic Mental Health Department, Haukeland University Hospital, Bergen, Norway
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Venke A Johansen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway; Resource Centre on Violence, Traumatic Stress and Suicide Prevention, Western Norway (RVTS West), Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
11
|
Kurniawati ER, Rutjens VGH, Vranken NPA, Delnoij TSR, Lorusso R, van der Horst ICC, Maessen JG, Weerwind PW. Quality of life following adult veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review. Qual Life Res 2021; 30:2123-2135. [PMID: 33826058 PMCID: PMC8024673 DOI: 10.1007/s11136-021-02834-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used successfully for the past decade in adult patients with acute respiratory distress syndrome (ARDS) refractory to conventional ventilatory support. However, knowledge of the health-related quality of life (HRQoL) in VV-ECMO patients is still limited. Thus, this study aimed to provide a comprehensive overview of the HRQoL following VV-ECMO support in ARDS patients. METHODS A systematic search was performed on PubMed and Web of Science databases from January 1st, 2009 to October 19th, 2020. Studies reporting on HRQoL following VV-ECMO for ARDS in adults were included. Two authors independently selected studies, extracted data, and assessed methodological quality. RESULTS Eight studies were eligible for inclusion, consisting of seven observational studies and one randomized controlled trial (total N = 441). All eight studies had a quantitative design and reported 265 VV-ECMO survivors to have a reduced HRQoL compared to a generally healthy population. Follow-up time varied between six months to three years. Additionally, only four studies (total N = 335) compared the HRQoL of VV-ECMO (N = 159) to conventionally treated survivors (N = 176), with one study showing a significantly better HRQoL in VV-ECMO survivors, while three studies were stating comparable HRQoL across groups. Notably, most survivors in these studies appeared to experience varying degrees of anxiety, depression, and post-traumatic stress disorder (PTSD). CONCLUSIONS ARDS survivors supported by VV-ECMO have a decline in HRQoL and suffered from physical and psychological impairments. This HRQoL reduction is comparable or even better to the HRQoL in conventionally treated ARDS survivors.
Collapse
Affiliation(s)
- E R Kurniawati
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - V G H Rutjens
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - N P A Vranken
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - T S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - R Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - I C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - J G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - P W Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
12
|
Guenther SPW, Hornung R, Joskowiak D, Vlachea P, Feil K, Orban M, Peterss S, Born F, Hausleiter J, Massberg S, Hagl C. Extracorporeal life support in therapy-refractory cardiocirculatory failure: looking beyond 30 days. Interact Cardiovasc Thorac Surg 2020; 32:607-615. [PMID: 33347585 DOI: 10.1093/icvts/ivaa312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Venoarterial extracorporeal life support (ECLS) has emerged as a potentially life-saving treatment option in therapy-refractory cardiocirculatory failure, but longer-term outcome is poorly defined. Here, we present a comprehensive follow-up analysis covering all major organ systems. METHODS From February 2012 to December 2016, 180 patients were treated with ECLS for therapy-refractory cardiogenic shock or cardiac arrest. The 30-day survival was 43.9%, and 30-day survivors (n = 79) underwent follow-up analysis with the assessment of medium-term survival, quality of life, neuropsychological, cardiopulmonary and end-organ status. RESULTS After a median of 1.9 (1.1-3.6) years (182.4 patient years), 45 of the 79 patients (57.0%) were alive, 35.4% had died and 7.6% were lost to follow-up. Follow-up survival estimates were 78.0% at 1, 61.2% at 3 and 55.1% at 5 years. NYHA class at follow-up was ≤II for 83.3%. The median creatinine was 1.1 (1.0-1.4) mg/dl, and the median bilirubin was 0.8 (0.5-1.0) mg/dl. No patient required dialysis. Overall, 94.4% were free from moderate or severe disability, although 11.1% needed care. Full re-integration into social life was reported by 58.3%, and 39.4% were working. Quality of life was favourable for mental components, but a subset showed deficits in physical aspects. While age was the only peri-implantation parameter significantly predicting medium-term survival, adverse events and functional status at discharge or 30 days were strong predictors. CONCLUSIONS This study demonstrates positive medium-term outcome with high rates of independence in daily life and self-care but a subset of 10-20% suffered from sustained impairments. Our results indicate that peri-implantation parameters lack predictive power but downstream morbidity and functional status at discharge or 30 days can help identify patients at risk for poor recovery.
Collapse
Affiliation(s)
- Sabina P W Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Roman Hornung
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian-University, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Martin Orban
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Jörg Hausleiter
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Steffen Massberg
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| |
Collapse
|
13
|
Savas H, Ozdemir Koken Z, Senol Celik S. Experiences of adult extracorporeal membrane oxygenation patients following discharge: A mixed methods study. Heart Lung 2020; 49:592-598. [PMID: 32216973 DOI: 10.1016/j.hrtlng.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Survival and discharge rates after extracorporeal membrane oxygenation are gradually increasing. More research is warranted to investigate extracorporeal membrane oxygenation patients' post-discharge experiences, problems and quality of life. OBJECTIVE The aim of this study was to determine adult extracorporeal membrane oxygenation patients' experiences, problems and quality of life following discharge. METHODS A mixed methods research was used. Study sample consisted of 11 adult extracorporeal membrane oxygenation patients discharged at least one month prior to study entry. In-depth interviews were conducted. Participants' quality of life was assessed using the EuroQol 5 Dimension 5 Level questionnaire. RESULTS Two categories (pre- and post-discharge), 7 themes and 16 sub-themes were developed based on in-depth interviews. According to the EuroQol 5 Dimension 5 Level, participants had high perceptions of health. CONCLUSION Extracorporeal membrane oxygenation patients should be provided with comprehensive post-discharge education, exercise programs, social support and regular home visits for post-discharge assessment and follow-up care.
Collapse
Affiliation(s)
- Hafize Savas
- Nursing Department, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey.
| | - Zeliha Ozdemir Koken
- Surgical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Sevilay Senol Celik
- Surgical Nursing Department, Faculty of Nursing, Koç University, Istanbul, Turkey
| |
Collapse
|
14
|
Tiedebohl JM, DeFabio ME, Bell T, Buchko BL, Woods AB. ECMO survivors' quality of life and needs after discharge: A descriptive, comparative cross-sectional pilot study. Intensive Crit Care Nurs 2020; 59:102829. [PMID: 32173238 DOI: 10.1016/j.iccn.2020.102829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/30/2019] [Accepted: 02/09/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To describe gender differences in health-related quality of life and characterise discharged patients' perceptions of follow-up needs after extracorporeal membrane oxygenation. RESEARCH METHODOLOGY/DESIGN A descriptive, comparative cross-sectional pilot design was used. Adult patients receiving extracorporeal membrane oxygenation discharged between January 1, 2016 and March 31, 2018 participated in telephone interviews. SETTING A 580-bed community teaching hospital in south central Pennsylvania. MAIN OUTCOME MEASURES Health-related quality of life was measured with the Rand 36-item Short Form Health Survey. Open-ended questions identified post-discharge healthcare services and perceived follow-up needs. RESULTS Of 30 eligible patients, 24 completed a telephone interview. All health-related quality of life dimensions, except for role-emotional and mental health, were lower in post- extracorporeal membrane oxygenation patients at follow-up compared to national norms. Women scored lower than men in all health-related quality of life dimensions. The most frequent post-discharge services used were physical therapy (66.7%), rehabilitation (62.5%) and occupational therapy (54.2%). The need for coordination of care post-discharge was identified. CONCLUSIONS Given long-term sequelae of extracorporeal membrane oxygenation on health-related quality of life and gender differences in health-related quality of life outcomes, ongoing interdisciplinary follow-up is imperative to ensure comprehensive patient management across the continuum of care.
Collapse
Affiliation(s)
| | | | - Theodore Bell
- WellSpan Health, 1001 S. George St., York, York, PA 17403, USA
| | | | - Anne B Woods
- WellSpan Health, 1001 S. George St., York, York, PA 17403, USA
| |
Collapse
|
15
|
Knudson KA, Gustafson CM, Sadler LS, Whittemore R, Redeker NS, Andrews LK, Mangi A, Funk M. Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): An integrative review. Heart Lung 2019; 48:538-552. [DOI: 10.1016/j.hrtlng.2019.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
|
16
|
Ørbo MC, Karlsen SF, Pedersen EP, Hermansen SE, Rønning PB, Nergaard KA, Naesheim T, Myrmel T. Health-related quality of life after extracorporeal membrane oxygenation: a single centre's experience. ESC Heart Fail 2019; 6:701-710. [PMID: 31066213 PMCID: PMC6676289 DOI: 10.1002/ehf2.12433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Aims The aims of this study were to evaluate health‐related quality of life (HRQL) among patients treated with extracorporeal membrane oxygenation (ECMO) in northern Norway over a period of 27 years (1988–2015) and to identify variables related to HRQL. Methods and results A retrospective inquiry of the ECMO registry at the University Hospital of North Norway identified 74 ECMO‐treated patients (mean age 49 years, 65% males). Acute cardiac failure was the dominant indication (58%), and venoarterial ECMO was the dominant mode of treatment (87%). Mortality for discharged patients was recorded on 20 September 2016. Thirty (41%) survivors were identified. Twenty‐three survivors were eligible for the survey and received a set of questionnaires at home. The main outcome measure was HRQL as measured with the 36‐item Short‐Form health survey (SF‐36) (RAND Short Form‐36 v1.2). Other questionnaires covered demographic information, problems with functioning in usual daily activities (such as hobbies, household chores, family, or work), employment status, and psychological distress. The survey was completed by 20 (87%) survivors (mean age = 49 years, 12 men). Indications for ECMO treatment (VA = 90%) had been respiratory failure (25%), cardiac failure (60%), and extracorporeal cardiopulmonary resuscitation (15%). The average time since ECMO treatment was 6.5 years. Seventy‐five percent reported mental HRQL (SF‐36 Mental Component Summary, mean = 43, SD = 5) or physical HRQL (SF‐36 Physical Component Summary, mean = 43, SD = 4.5) within the normal range (T = 50 ± 10) in comparison with age‐matched population data from national norms. Half of the responders reported problems on the SF‐36 subscales general health and role physical. Seventy percent reported problems on the SF‐36 subscale role emotional. All but one responder lived independently without any organized care, and 90% reported no problems related to basic self‐care. Half of those in working age had returned to work after ECMO treatment. Forty percent of the responders reported some degree of restrictions in usual daily activities, problems with mobility (35%), anxiety/depression (35%), or pain/discomfort (55%). Significant univariate associations were observed for poorer HRQL and higher reports of psychological distress, pain, and experiencing restrictions in usual everyday activities. Improved HRQL was significantly related to an extended time since ECMO treatment. Conclusions Our survey indicates an overall positive long‐term HRQL outcome for our ECMO survivors. A subset reported problems with functioning and HRQL. Future research should focus on identification of the survivors at risk for poor recovery who may benefit from rehabilitation interventions.
Collapse
Affiliation(s)
- Marte Christine Ørbo
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Sidsel Fredheim Karlsen
- Department of Cardiology, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Ellinor Phillips Pedersen
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Stig Eggen Hermansen
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Per Bjørnerud Rønning
- Department of Cardiology, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
| | - Kathrine Aas Nergaard
- Division of Surgical Medicine and Intensive Care, Clinic of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway
| | - Torvind Naesheim
- Division of Surgical Medicine and Intensive Care, Clinic of Emergency Medical Services, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Truls Myrmel
- Department of Cardiothoracic and Vascular Surgery, Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
17
|
Chen KH, Chen YT, Yeh SL, Weng LC, Tsai FC. Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study. PLoS One 2018; 13:e0196778. [PMID: 29746522 PMCID: PMC5945013 DOI: 10.1371/journal.pone.0196778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 04/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients’ survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study’s aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period. Study design A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants’ QOL at 12 months after discharge was compared with the general population. Results A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores. Conclusions This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.
Collapse
Affiliation(s)
- Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Yu-Ting Chen
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital and Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of General Surgery, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan
- * E-mail:
| |
Collapse
|
18
|
Quality of Life of Adult Survivors After Extra Corporeal Membrane Oxygenation (ECMO). Dimens Crit Care Nurs 2018; 37:12-17. [DOI: 10.1097/dcc.0000000000000278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
19
|
Adjunctive Hyperbaric Oxygen Therapy for Healing of Chronic Diabetic Foot Ulcers. J Wound Ostomy Continence Nurs 2017; 44:536-545. [DOI: 10.1097/won.0000000000000374] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Aiello S, Loomba RS, Kriz C, Buelow M, Aggarwal S, Arora RR. The Need for Extracorporeal Membrane Oxygenation in Adults Undergoing Congenital Heart Surgery: Impact and Trends of Utilization. Indian J Crit Care Med 2017; 21:547-551. [PMID: 28970652 PMCID: PMC5613604 DOI: 10.4103/ijccm.ijccm_169_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Adults with congenital heart disease (ACHD) represent a population with unique health-care needs. Many patients require cardiac surgery, with some requiring postoperative extracorporeal membrane oxygenation (ECMO). This study aimed to identify the risk factors for the need of postoperative ECMO and characterize the impact of ECMO on admission characteristics. Methods: Data from the 2005–2012 iterations of the Nationwide Inpatient Sample were used. ACHD admissions over 18 years with a documented cardiac surgery were included. Univariate analysis was conducted to compare the characteristics between those requiring ECMO and those who did not. Regression analysis was done to identify the independent risk factors associated with ECMO and to determine the impact of ECMO on length, cost, and mortality of the admission. Results: A total of 186,829 admissions were included. Of these, 446 (0.2%) admissions required ECMO. Those with acute kidney injury, double-outlet right ventricle, or total anomalous pulmonary venous connection were more likely to require ECMO. ECMO was also significantly more utilized in patients undergoing septal defect repair, complete repair of tetralogy of Fallot, atrial switch, and heart transplant. The use of ECMO significantly increased length, cost, and mortality of stay. Overall mortality was 62.6% in the ECMO group. Conclusion: ECMO is only needed in a small proportion of postoperative ACHD patients. The use of ECMO significantly increases cost, length of stay and mortality in these patients. Improved identification of postoperative ACHD patients who are more likely to survive ECMO may facilitate improved survival and decreased resource utilization.
Collapse
Affiliation(s)
- Salvatore Aiello
- Division of Cardiology, Chicago Medical School, North Chicago, IL, USA
| | - Rohit S Loomba
- Division of Cardiology, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Connor Kriz
- Division of Cardiology, Chicago Medical School, North Chicago, IL, USA
| | - Matthew Buelow
- Division of Cardiology, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saurabh Aggarwal
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Rohit R Arora
- Division of Cardiology, Chicago Medical School, North Chicago, IL, USA
| |
Collapse
|