(123) Trauma-Related Psychopathologies After Extracorporeal Membrane Oxygenation Support

Introduction: ECMO use has been associated with substantial psychological morbidity in patients and their family members. This study quantifies the prevalence of trauma-related psychopathologies (i.e. post-traumatic stress disorder, anxiety, and depression) in ECMO patients and their families.

Methods: We conducted a systematic review and meta-analysis using multiple electronic databases, including all studies from database inception until April 15, 2024. We evaluated the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression among ECMO survivors and their families. To address small proportions and confidence intervals close to zero, we applied an arcsin transformation to pool individual proportions. Random-effect models were utilized to pool proportions, assuming each study estimated a study-specific true effect.

Results: Of 1768 screened studies, 55 were included (5146 subjects): 50 studies reported outcomes in adult ECMO survivors, 1 in pediatric ECMO survivors, 2 in families of adult ECMO patients, and 2 in families of pediatric ECMO patients. The pooled prevalence of PTSD was 19% in adult ECMO survivors (95%CI 15;24, I2=76%, n=1247), 20% in pediatric ECMO survivors (95%CI 6;51, n=10), 25% in families of adult ECMO patients (95%CI 7;49, I2=60%, n=39), and 22% in families of pediatric ECMO patients (95%CI 12;34, n=52). The pooled prevalence of anxiety was 30% in adult ECMO survivors (95%CI 24;36, I2=84%, n=1487), 67% in families of adult ECMO patients (95%CI 33;93, I2=89%, n=76), and 56% in families of pediatric ECMO patients (95%CI 33;77, n=16). The pooled prevalence of depression was 24% in adult ECMO survivors (95%CI 20;28, I2=85%, n=4598), 50% in families of adult ECMO patients (95%CI 27;72, I2=76%, n=76), and 38% in families of pediatric ECMO patients (95%CI 19;61, n=16).

Conclusions: In this meta-analysis of 55 observational studies, we found that in adult ECMO survivors, one in five experienced PTSD, one in three experienced anxiety, and one in four experienced depression. Family members had an even higher prevalence of trauma-related psychopathologies. There is a striking lack of evidence regarding trauma-related psychopathology in pediatric survivors and in the families of both pediatric and adult ECMO patients