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A first global study, led by critical care researcher Professor Carol Hodgson, found that after lifesaving support involving extracorporeal membrane oxygenation (ECMO), death and disability were common, with only a third patients alive and without disability six months after the start of treatment.
ECMO is a recent development in critical care that saves lives, providing respiratory support to patients unable to breathe on their own. Expensive and complex machines extract blood, remove carbon dioxide and re-oxygenate the blood before returning it to the body.
The technology is certainly life-saving for some, but the speed with which it has been adopted during the pandemic means that despite widespread adoption, few studies have assessed the conditions in which it can be used in the most beneficial and most effective way. profitable.
The study was published in Lancet Respiratory Medicine. This is the first long-term multicenter prospective cohort study of the incidence of people surviving with or without disability following the use of ECMO in intensive care units. The research is important not only to build an evidence base for best practice, but also because patients’ families are often unaware of the long-term consequences of ECMO, according to Professor Hodgson.
“It’s been very difficult to conduct ethical randomized trials on these very sick patients, that is, to offer a potentially life-saving therapy like ECMO to one group but not another,” he said. she declared.
The study drew data from the EXCEL Registry, Australia’s national clinical registry that was launched in 2019 to capture standardized data on ECMO use and patient outcomes. Data from this study included 391 patients from 23 hospitals, who were treated with ECMO between February 2019 and December 2020, representing both pre-pandemic and early pandemic use.
Disability was common in all domains of functioning six months after the start of treatment, including physical, psychological and cognitive domains.
“Admission to intensive care is only for the sickest patients, and this degree of illness often leads to a very long road to recovery, physically and cognitively. It can also create enormous psychological strain, as people can be traumatized by their experience and feel sadness and frustration struggling to undertake “simple” daily activities.
ECMO is an expensive business – the average cost is $200,000 per patient. Professor Hodgson says clinicians are currently divided by those who think it should be provided to all patients who need it, while others argue it should be relegated to only those who will benefit from it, the savings funds being used on more proven treatments.
“We still have a lot to learn about which patients will do well after ECMO,” Prof Hodgson said. “I think it’s important for the patient’s family to receive information about the risk of disability once a patient is on ECMO.”
Professor Hodgson is working with colleagues across Australia to develop new guidance for the NHMRC on the use of ECMO.
Learn more about ECMO here; and read patient experiences after ECMO here.
Read more about Professor Hodgson’s work in critical care research here.
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