Quality of life after awake veno-arterial extracorporeal membrane oxygenation implementation for refractory cardiogenic shock

Position du problème et objectif(s) de l’étude

Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a life-support therapy that may be used to treat patients with a refractory cardiogenic shock (RCS) [1]. Usually, ECMO implementation is performed under General Anesthesia (GA) and requires mechanical ventilation. Unfortunately, complications of mechanical ventilation are well known, such as lung trauma or ventilator-associated pneumonia (VAP) [2,3]. In addition, GA can worsen hemodynamic outcomes in patients that already encounter hemodynamic instability. Awake ECMO implementation is an alternative strategy that may lead to better clinical outcomes [4]. As it is an invasive procedure performed while the patient is still conscious, there are concerns about the psychological disorders and quality of life (QoL) after intensive care unit (ICU) stay. In fact, testimonies show that this technique could leave long term traumatic memories [5]. The aim of this study was to assess the impact of Awake ECMO procedure on QoL after surviving an Intensive Care Unit (ICU) stay.

Matériel et méthodes

This retrospective cohort was conducted between the 1st of January, 2020 the 31st of December, 2024 in a single center cardiac surgery ICU. Consecutive patients over 18 years old who required a ECMO implementation for RCS were included. Data concerning comorbidities, anesthesia strategy during ECMO implementation, ICU stay and outcomes after ICU discharge were collected. Two groups were defined according to anesthesia strategy during ECMO implementation: GA group and Awake group. Data on QoL and psychological disorder after ICU stay were assessed in a face-to-face or telephonic post-ICU consultation, with the Hospital Anxiety and Depression (HAD) scale [6], the Post Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)[7] and the Short Form-12 Items (SF-12), split in Physical Component Score (PCS) and Mental Component Score (MCS)[8]. The study was approved by a local Ethics Committee (IRBN532025/CHUSTE).

Résultats & Discussion

During study period, 206 patients underwent VA-ECMO (Figure 1). A total of 45 patients were included. Among the 23 survivors, 13 (57%) were included in the GA group and 10 (43 %) in the Awake group. 17 patients (10 in the GA group and 7 in the Awake group) were included in the final analysis after 6 patients were lost to follow-up. The PCS in the Awake group was significantly higher than in the AG group (Mean Absolute Difference = 11.26; p = 0.05). There was no significant difference for other psychological or QoL outcomes. Mortality was similar between the two groups (OR = 1.35; 95% CI [0.41; 4.46]; p=0.63). There was more VAP in the GA group (p = 0.01).

Conclusion

Awake VA-ECMO implementation did not impact psychological status after ICU stay compared to the GA procedure. Regarding the complications that could be caused by GA, Awake ECMO technique represents a good alternative for RCS therapy.

Auteurs

Aurélien CROUZET (1) , Julien LANOISELÉE (1), Jean-Baptiste BOUCHET (1), Serge MOLLIEX (1), Kasra AZARNOUSH (2), Jerome MOREL (1), Nory ELHADJENE (1) - (1)Department Of Anesthesia And Critical Care, University Hospital Of Saint-Etienne, Saint-Priest-En-Jarez, France, Saint-Étienne, France, (2)Department Of Cardiac Surgery, University Hospital Of Saint-Etienne, Saint-Priest-En-Jarez, France, Saint-Étienne, France

Orateur(s)

Aurélien CROUZET (Saint-Étienne)