Surviving ECMO is a longitudinal process not a binary event: A survivorship model to address quality-of-life and resource consumption for 36 months after life-threatening respiratory failure

Purpose: Extracorporeal membrane oxygenation (ECMO) emerged as a salvage therapy for patients with severe COVID-19-related acute respiratory distress syndrome (ARDS). Evidence suggests that survivors continue to struggle with daily activities. We sought to evaluate a survivorship model to improve quality of life and resource consumption based on a cancer survivorship model.

Methods: We established a virtual and physical survivorship clinic using telehealth, in-person counseling, and Physical and Occupational Therapy moderated by a clinical navigator situated in a multidisciplinary outpatient setting. Resource consumption and quality of life metrics were analyzed using the 12-item Short-Form Health Survey (SF-12). Between 2020 and 2023, three separate in-person or phone interviews were conducted at approximately six months, one year, and two years from decannulation. Mental and physical quality of life (QoL) scores were used to calculate quality-adjusted life years (QALYs) that were compared to averages of the United States population. The relationship between QoL metrics, costs, and length of stay (LOS) outcomes was assessed using generalized linear models and mixed models with a Gaussian distribution family. QoL scores were dependent variables and accounted for patients as layers (grouping or random effects).

Results: 53 patients in the survivorship program were followed for three years. 98.1% of patients were white, 50.9% were male, and the mean age was 41.7. All patients were alive at discharge. The mean hospital LOS was 28.9 days and the mean ICU LOS was 22.6 days. The average ECMO costs were $40,164 and the average total hospitalization cost was $303,321. The mean SF-12 mental scores (MSC-12) were 52.9, 50, and 49.7. The mean physical scores (PCS-12) were 43.7, 41.8, and 47.3. The mean QALYs were 0.837, 0.829, and 0.826. No significant differences existed between the first, second, and third evaluations of QoL metrics. The MCS-12 scores showed no significant differences compared to the United States population in all assessments. The PCS-12 scores were significantly lower during the first and second evaluations (p < 0.001). The 36-month PCS-12 assessment did not reveal any significant difference. The QALYs were significantly higher during all three evaluations (p < 0.001). Longer hospital stays, ICU stays, and higher costs were linked to lower PCS-12 scores compared to the general population. There was a negative correlation between cost and QALYs.

Conclusion: Extracorporeal support is associated with high resource consumption and physical and psychological limitations. The survivorship approach to caring for patients who require ECMO for life-threatening respiratory illness yields acceptable QoL metrics. This may be improved through a survivorship model to improve QoL after discharge and the cost-effectiveness of ECMO.

Identify the source of the funding for this research project: Supported by NIH NHLBI # 2UM1 HL088925 12