Table 2.
Study characteristics
| Parameter | First author and origin of the study | |||||||
|---|---|---|---|---|---|---|---|---|
| Galazzi et al. [39] Italy |
Grasselli et al. [40] Italy |
Hodgson et al. [41] Australia |
O’Brien et al. [42] Ireland |
Peek et al. [43] UK |
Sanfilippo et al. [44] Italy |
Sylvestre et al. [45] France |
Wang et al. [46] China |
|
| Study design | Quantitative retrospective observational study (cohort) | Quantitative prospective observational study (cohort) | Quantitative retrospective observational study (cohort) | Quantitative retrospective observational study (cohort) | Quantitative randomized controlled trial (RCT) | Quantitative prospective observational study (cohort) | Quantitative retrospective observational study (cohort) | Quantitative prospective observational study (cohort) |
| Total population (N)—HRQoL sample size | ||||||||
| VV-ECMO | 26–17 | 26–18 | 18–15 | 19–13 | 57–52 | 43–33 | 49–22 | 27–24 |
| MV | N/A | 31–19 | N/A | N/A | 46–32 | N/A | 36–18 | 63–48 |
| Sex (M) (%) | ||||||||
| VV-ECMO | 12 (70%) | 24 (70%) | 10 (48%) | 7 (54%) | 51 (57%) | 24 (73%) | 12 (55%) | 18 (75%) |
| MV | N/A | 31 (62%) | N/A | N/A | 53 (59%) | N/A | 11 (61%) | 33 (69%) |
| Age (years) | ||||||||
| VV-ECMO | 49 (38–55) | 54 (41–63) | 36.3 ± 12.1 | 44 ± 11 | 39.9 ± 13.4 | 45.0 ± 9.8 | 41 (32–56) | 38.0 ± 15.1 |
| MV | N/A | 54 (45–70) | N/A | N/A | 40.4 ± 13.4 | N/A | 51 (43–63) | 44.3 ± 15.6 |
| VV-ECMO duration (days) | ||||||||
| VV-ECMO | 19 (15–33) | 9 (6–13) | 10.6 (3.6–15.8) | 15 (11–19) | 9 (6–16) | 10 (7–15) | 12 (8–19) | 6.0 ± 2.3 |
| MV | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| MV duration (days) | ||||||||
| VV-ECMO | 36 (12–74) | 21 (11–35) | 15.3 (12.0–23.2) | 3 (2–20) of pre-ECMO | 10 (4.8–22.8) | 2 (1–4) days pre-ECMO and 9 (4–16) days post-ECMO | 36 (28–64) | 10.0 (6.0–16.3) |
| MV | N/A | 8 (5–21) | N/A | N/A | 11 (4.0–20.3) | N/A | 29 (21–46) | 9.0 (6.0–13.0) |
| ICU stay (days) | ||||||||
| VV-ECMO | 37 (20–79) | 24 (15–36) | 20.7 (14.9–28.6) | 31 (25–74) | 24 (13.0–40.5) | 2 (1–7) but only pre-ECMO | 46 (34–71) | 13.0 (9.8–22.3) |
| MV | N/A | 11 (5–25) | N/A | N/A | 13 (11–16) | N/A | 35 (24–47) | 11.0 (8.0–18.0) |
| Hospital stay (days) | ||||||||
| VV-EMCO | N/A | 33 (19–48) | 28.4 (18.5–37.7) | N/A | 35 (15.6–74.0) | 4 (2–8) but only pre-ECMO | 61 (45–99) | 25.5 (16.5–31.3) |
| MV | N/A | 23 (12–45) | N/A | N/A | 17 (4.8–45.3) | N/A | 55 (43–90) | 26.0 (15.0–56.3) |
| Discharge destination | ||||||||
| VV-ECMO | N/A | 92% to home; 8% to other hospital | 44% to home; 50% to other hospital; 6% to rehabilitation facility | 47% to referral hospital; 23% to a rehabilitation center; 31% to home | N/A | N/A | N/A | 92% to home; 8% to other hospital |
| MV | N/A | 90% to home; 10% to other | N/A | N/A | N/A | N/A | N/A | 90% to home; 10% to other |
| Follow-up time (months) | ||||||||
| VV-ECMO | 17 (14–25) | 12 | 8.4 (6–16) | 36 (14–39) | 6 | 2.7 (2–5) years | 20 (17–22) | 12.7 ± 5.8 |
| MV | N/A | 12 | N/A | N/A | 6 | N/A | 22 (18–23) | 14.8 ± 6.5 |
| HRQoL assessment tool(s) | EQ-5D | SF-36, SGRQ, IES-R | SF-36, EQ-5D | SF-36, HADS, IES-R | SF-36, EQ-5D, SGRQ, HADS, mini-mental examination, and specific questions about sleep | SF-36, HADS, CES-D, IES-R | SF-36, BDI-IA, BAI, IES | SF-36, EQ-5D |
| Reported HRQoL outcomes | Perceived QoL = 75%; 60% showed good outcomes physically and psychosocially; 71% returned to their normal working activities | One-year survival was similar between VV-ECMO and MV; Both groups had almost full recovery of lung function; MV patients reported more fatigue, weakness, and limitation in daily activities; VV-ECMO survivors had higher HRQoL scores and lower PTSD rates than non-ECMO survivors | Mean VV-ECMO SF-36 scores were significantly lower compared to matched healthy controls for all domains except bodily pain and role-emotional; 42% of survivors were unable to perform usual activities and described severe or extreme anxiety and depression; 80% of survivors had no problem with personal care; 52% returned to work and 29% returned to previous work level at the follow-up time | Significantly lower mean SF-36 of physical functioning and physical component scores for VV-ECMO survivors. No statistical difference was found in the SF-36 scores between VV-ECMO survivors and matched general population in Ireland for the following domains: mental health, social function, vitality, and a mental component. Results from the HADS questionnaire showed that seven participants (54%) of VV-ECMO survivors experienced anxiety of which five of whom (38.5%) suffered from severe anxiety. Two participants (15%) showed a HADS-D score of ≥ 8, which is associated with depression. Three participants (23%) were considered to be at risk for PTSD. Four of the six (67%) of participants had returned to work at the follow-up time | No significant differences were found between VV-ECMO and MV for EQ-5D, SF-36, St George’s hospital respiratory questionnaire, hospital anxiety and depression scale, and mini-mental state examination | Physical role limitations and general-health perceptions were the worst SF-36 domains (25 and 56, respectively). Psychological tests showed high risk of depression (39–42%, patients; 39–52%, caregivers), anxiety (42% patients; 39% caregivers), and PTSD (47% patients; 61% caregivers). Patients depression or anxiety scores were correlated to age and the outcome reported by caregivers | Lower cognitive function was experienced by 55% of ECMO and 56% of MV survivors. ECMO and MV survivors had similar depressive symptoms (36% vs 39%, respectively), as well as anxiety symptoms (55% vs 44%, respectively) and PTSD (33% vs 44%, respectively). At the follow-up time, 46% of VV-ECMO had returned to their original work as compared to 67% of MV survivors | No statistically differences were found in EQ-between VV-ECMO and MV scores; 13% VV-ECMO and 15% MV reported fatigue and decreased endurance; 42% VV-ECMO and 27% MV reported symptoms of anxiety or depression; 67% VV-ECMO and 50% MV survivors returned to work |
VV-ECMO = veno-venous extracorporeal life support, MV = mechanical ventilation (considered to be the conventional treatment group); EQ-5D = EuroQol 5-Dimensions; SF-36 = Short Form 36; SGRQ = St. George’s Respiratory Questionnaire; IES-R = Impact of Event Scale-Revised; HADS = Hospital Anxiety and Depression Scale; N/A = not available; CES-D = Centre for Epidemiologic Studies Depression; BDI-IA = Beck Depression Inventory; BAI = Beck Anxiety Inventory; Values are expressed as mean ± standard deviation or median (25% IQR-75% IQR)