PMID- 37163480 OWN - NLM STAT- MEDLINE DCOM- 20230831 LR - 20240325 IS - 1530-0293 (Electronic) IS - 0090-3493 (Linking) VI - 51 IP - 9 DP - 2023 Sep 1 TI - Sounding the Alarm: What Clinicians Need to Know about Physical, Emotional, and Cognitive Recovery After Venoarterial Extracorporeal Membrane Oxygenation. PG - 1234-1245 LID - 10.1097/CCM.0000000000005900 [doi] AB - OBJECTIVE: We summarize the existing data on the occurrence of physical, emotional, and cognitive dysfunction associated with postintensive care syndrome (PICS) in adult survivors of venoarterial extracorporeal membrane oxygenation (VA-ECMO). DATA SOURCES: MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched. STUDY SELECTION: Peer-reviewed studies of adults receiving VA-ECMO for any reason with at least one measure of health-related quality of life outcomes or PICS at long-term follow-up of at least 6 months were included. DATA EXTRACTION: The participant demographics and baseline characteristics, in-hospital outcomes, long-term health outcomes, quality of life outcome measures, and prevalence of PICS were extracted. DATA SYNTHESIS: Twenty-seven studies met inclusion criteria encompassing 3,271 patients who were treated with VA-ECMO. The studies were limited to single- or two-center studies. Outcomes variables and follow-up time points evaluated were widely heterogeneous which limits comprehensive analysis of PICS after VA-ECMO. In general, the longer-term PICS-related outcomes of survivors of VA-ECMO were worse than the general population, and approaching that of patients with chronic disease. Available studies identified high rates of abnormal 6-minute walk distance, depression, anxiety, and posttraumatic stress disorder that persisted for years. Half or fewer survivors return to work years after discharge. Only 2 of 27 studies examined cognitive outcomes and no studies evaluated cognitive dysfunction within the first year of recovery. No studies evaluated the impact of targeted interventions on these outcomes. CONCLUSIONS: Survivors of VA-ECMO represent a population of critically ill patients at high risk for deficits in physical, emotional, and cognitive function related to PICS. This systematic review highlights the alarming reality that PICS and in particular, neurocognitive outcomes, in survivors of VA-ECMO are understudied, underrecognized, and thus likely undertreated. These results underscore the imperative that we look beyond survival to focus on understanding the burden of survivorship with the goal of optimizing recovery and outcomes after these life-saving interventions. Future prospective, multicenter, longitudinal studies in recovery after VA-ECMO are justified. CI - Copyright (c) 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. FAU - Higa, Kelly C AU - Higa KC AD - Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA. FAU - Mayer, Kirby AU - Mayer K AD - Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY. FAU - Quinn, Christopher AU - Quinn C AD - Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO. FAU - Jubina, Lindsey AU - Jubina L AD - Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY. FAU - Suarez-Pierre, Alejandro AU - Suarez-Pierre A AD - Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO. FAU - Colborn, Kathryn AU - Colborn K AD - Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO. FAU - Jolley, Sarah E AU - Jolley SE AD - Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO. FAU - Enfield, Kyle AU - Enfield K AD - Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA. FAU - Zwischenberger, Joseph AU - Zwischenberger J AD - Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY. FAU - Sevin, Carla M AU - Sevin CM AD - Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, TN. FAU - Rove, Jessica Y AU - Rove JY AD - Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO. LA - eng GR - K23 AA026315/AA/NIAAA NIH HHS/United States GR - K23 AR079583/AR/NIAMS NIH HHS/United States GR - L32 MD017732/MD/NIMHD NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20230501 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 RN - postintensive care syndrome SB - IM CIN - Crit Care Med. 2023 Sep 1;51(9):1278-1280. PMID: 37589522 MH - Adult MH - Humans MH - Anxiety MH - *Cognition MH - *Extracorporeal Membrane Oxygenation/methods MH - Multicenter Studies as Topic MH - *Quality of Life MH - Retrospective Studies MH - *Stress Disorders, Post-Traumatic/epidemiology/therapy COIS- Dr. Sevin's institution received funding from the Department of Defense. The remaining authors have disclosed that they do not have any potential conflict of interest. EDAT- 2023/05/10 18:41 MHDA- 2023/08/18 06:43 CRDT- 2023/05/10 13:24 PHST- 2023/08/18 06:43 [medline] PHST- 2023/05/10 18:41 [pubmed] PHST- 2023/05/10 13:24 [entrez] AID - 00003246-202309000-00014 [pii] AID - 10.1097/CCM.0000000000005900 [doi] PST - ppublish SO - Crit Care Med. 2023 Sep 1;51(9):1234-1245. doi: 10.1097/CCM.0000000000005900. Epub 2023 May 1.