Living after veno-arterial extracorporeal membrane oxygenator support: post-traumatic stress disorder symptoms
Authors: Alonso Fernandez De Gatta M , Gonzalez Cebrian M , Merchan Gomez S , Toranzo Nieto I , Diego Nieto A , Martin Herrero F , Barrio A , Rodriguez Estevez L , Sanchez PL 
Published: April 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future").

INTRODUCTION
Post-intensive care syndrome includes post-traumatic stress disorder (PTSD), reaching 27%. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides cardiopulmonary support in severe hemodynamic instability situations.

PURPOSE
Assess the prevalence of PTSD symptoms in adult survivors from Intensive Cardiac Care Unit (ICCU) admission requiring VA-ECMO support.
METHODS
Analysis of patients discharged after VA-ECMO in a referral hospital. They were screened through abbreviated Impact of Event Scale-6 (IES-6; 6 items). Its score was calculated as total (0-6 points) and mean (0-1). Respondents are asked to report their situation at the moment of screening (median time from discharge 31.4 [36] months).

RESULTS
Out of 135 VA-ECMO implants from 2013 to October 2020, 35.6% survived the ICCU admission.
After 31.4 [36] months follow-up, 40 patients remain alive. 34 patients responded to questionnaire. All patients required sedation and invasive mechanical ventilation. Baseline situation and complications are summarized in Table.
Total and mean score on the IES-6 were 1.26 ± 2.11 and 0.21 ± 0.35 respectively. Up to 29.4% of patients had PTSD symptoms (Figure).
The total and mean score in IES-6 was significantly correlated with the time elapsed since admission (R = 0.428, p = 0.012 and R = 0.427, p = 0.012 respectively). The patients with altered IES-6 items had passed a longer time since admission in ICCU (44 ± 15 vs 30 ± 20 months, p = 0.034).

CONCLUSION
Survivors from admission requiring VA-ECMO support show high prevalence of PTSD symptoms, appearing more frequently when more time has elapsed since admission. Special attention should be paid to psychological symptoms after VA-ECMO. Table. Implant status and complications Implant status and complications of VA-ECMO survivors.N = 34Age (years) (mean+ SD)Male (n, %)61.3 ± 1029 (85.3%)Brigde to (n,%) Recovery Transplant Ventricular assist device Elective High-risk PCI29 (85.3%)3 (8.8%)0 (0%)2 (5.9%)Indication (n,%)Cardiogenic shock Refractory cardiac arrest Electrical storm14 (41.1%)2 (5.9%)6 (17.6%)Percutaneous implant (n,%)Femoro-femoralIntraaortic balloon pump21 (61.8%)28 (82.4%)10 (29.4%)High-risk percutaneous coronary intervention Postcardiotomy shock 2 (5.9%)10 (29.4%)Time ECMO support (days)Time under mechanical ventilation (days)5.9 ± 3.614.5 ± 22pH (mean + SD)lactate (mmol/L) (mean + SD)7.3 ± 0.26.3 ± 4.6Complications (n,%) Vascular (bleeding, ischemia) Bleeding (minor or major) Critical care infections during admission10 (29.4%)11 (32.4%)20 (58.8%)Left ventricular ejection fraction (%) (mean + SD)Right ventricular dysfunction (n,%)30.6 ± 1620 (58.8%)Noradrenaline Dobutamine Adrenaline30 (88.2%)27 (79.4%)11 (32.4%)Ischemic/hemorragic stroke Renal replacement therapy Tracheostomy Critically illness polyneuropathy1 (2.9%)9 (26.5%)10 (29.4%)15 (44.1%)Preimplant cardiac arrest (n,%)Cardiac arrest duration (min) (n,%)Extracorporeal cardiopulmonary resuscitation (ECPR) (n,%)19 (55.9%)14 ± 143 (8.8%)Abstract Figure. IES-6 results.