Prediction of Survival and Quality of Life in Out-of-center Extracorporeal Membrane Oxygenation

Objectives: Despite progress in treatment of cardiopulmonary organ failure, the mortality rate for patients with acute organ failure remains high. Extracorporeal membrane oxygenation is since years an established therapy in treatment of patients with acute respiratory distress syndrome (ARDS) and cardiogenic shock. Especially for out-of-center implanted patients important data regarding survival, predictors of survival, quality of life (QOL) and quality-adjusted life years (QALY) are still insufficient explored.

Methods: 97 consecutive patients of our “Hallesches Extracorporeal Life-support Program” (HELP), treated with ECMO between 2010 and 2015, were analyzed. Pre-, intra- and post-hospital values were investigated, including survival (30 days, ICU, overall). Through multivariate logistic regression analysis predictors for in-hospital mortality could be identified. Long-term survivors were studied in detailed follow-up examinations (median time of 23.5 (IQR: 8–34) months after implant), including various tests concerning mental state, QOL and organ function. Additionally, QALYs could be calculated.

Results: In our cohort of 97 out-of-center implanted patients hospital survival was 50.5%. Thirty-five (71.4% of hospital survivors) patients were examined in detailed follow-up, 10 (20.4%) patients died after discharge and 4 (8.2%) were not able to participate. Median QOL was 80.0% in Karnofsky-Index, 80.6% in Euro-QoL-5D and 76.4% in QOL-I (normal reference: ≥80%; ≥75%; ≥70%). Mental function was 96.7% in MMST, 83.3% in DemTect and 87.0% in TFDD (normal reference: ≥90%; ≥72%; ≥74%). Through TTE and spirometry recovered organ function were shown (86.7% FVC, 85.8% VC Max, 61.0% EF). In multivariate regression analysis female gender, age, ventilation days pre-implantation, SOFA-Score and lactate were identified as predictors for adverse outcome. During hospital stay number of thrombocyte concentrates and dialysis were associated with in-hospital death. Related to 100 ECMO-patients 32.39 QALYs could be generated per year through treatment with ECMO.

Conclusion: Long-term survivors of out-of-center ECMO-implantation demonstrated good mental and quality of life conditions with well recovered cardiopulmonary function during follow-up. Ventilation time before ECMO-implantation, SOFA-Score and lactate values as predictors for adverse outcome should be considered during treatment of patients with cardiopulmonary organ failure.