(186) Long-Term Psychological Outcomes After Extracorporeal Membrane Oxygenation: A Meta-Analysis

Introduction: Adults recovering from hospitalization requiring extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure often face new or worsening physical, cognitive and psychological impairments affecting long-term outcomes. This systematic review is the first to provide a meta-analysis of long-term outcomes specific to psychological measures and ECMO.

Methods: A comprehensive search was conducted on PubMed/Medline, Web of Science and Cochrane databases through May 22, 2023 to identify quantitative studies reporting psychological outcome measures for adult survivors of ECMO. Studies excluded were qualitative study designs, case studies, reviews, editorials or non-English texts. Independent reviewers conducted screening and data extraction and completed quality assessment using the Critical Appraisal Skills Programme (CASP) systematic review checklist.

Results: Out of 3,111 studies, 30 met inclusion criteria representing 19 studies reporting on anxiety measures, 25 studies on depression, and 20 on post-traumatic stress disorder (PTSD). Quality assessment yielded that many of the included studies did not account for confounding factors (e.g., physical impairments, social stressors), and less than half employed a prospective study design. Meta-analytic estimation of pooled prevalence rates was conducted using GLMM with random effects. Overall, rates of psychological distress were higher in survivors of ECMO compared with the general population, with pooled prevalence estimates of 31% for anxiety, 22% for depression, and 23% for PTSD.

Conclusions: The prevalence of psychological distress during the post-hospital discharge period is likely higher for adults who received ECMO during hospitalization compared with the general population. The prevalence of anxiety, depression and PTSD experienced by ECMO survivors demonstrates addressable vulnerabilities that can benefit from clinical, research, and policy interventions. Future research should focus on longitudinal prospective designs and consider measuring confounders and/or include structured clinical interviews to assess and address mental health symptomatology.