Extracorporeal Membrane Oxygenation (ECMO) is an advanced form of life support. It acts as a temporary heart-lung bypass machine, adding oxygen and removing carbon dioxide from a patient’s blood outside the body. ECMO is typically a last-resort treatment for individuals with severe, life-threatening heart or lung conditions that have not responded to other therapies. This article examines patient outcomes after ECMO, including immediate and long-term survival rates and recovery quality.
Survival Rates Immediately Following ECMO
Immediate success after ECMO is often measured by survival to hospital discharge. These rates vary significantly based on patient age and the underlying reason for ECMO. For adults, overall hospital survival is around 58.7%. Adult patients receiving venovenous (VV) ECMO for respiratory failure show higher survival rates, approximately 57% to 69.9% to hospital discharge.
Conversely, adult patients supported by venoarterial (VA) ECMO for cardiac failure generally have lower immediate survival rates, often around 40% to 54.9% to hospital discharge. For pediatric patients, overall hospital survival can be around 60%. Neonates, especially those with congenital heart disease on prolonged VA ECMO, have a survival-to-hospital discharge rate of about 23.9%. However, neonates on ECMO for respiratory failure, such as meconium aspiration syndrome, show higher survival rates, sometimes reaching 74% to 94%.
Long-Term Survival Statistics
Long-term survival rates for ECMO survivors are monitored, though comprehensive data for extended periods can be less available. For adult patients, overall mortality rates at one month and one year after ECMO initiation can be as high as 59.8% and 76.5%, respectively. However, among those who survive to hospital discharge, the prognosis often improves.
For adults who survive the initial 30 days post-ECMO, 5-year survival rates are reported around 71% to 73% for both VA and VV ECMO patients. Data for 10-year survival in adults are more limited, but some studies indicate rates ranging from 9.7% to 17.6% for post-cardiotomy patients. For patients alive at 90 days, 87% may still be alive five years later. In pediatric patients, those who survive the initial 90-day period show promising long-term outcomes, with approximately 93% of neonates and 89% of pediatric patients still alive 10 years later.
Key Factors Influencing Outcomes
Several factors influence a patient’s prognosis following ECMO, affecting both immediate and long-term survival. These include patient-specific characteristics and ECMO-related factors.
Patient-Specific Factors
- Age: Younger patients, particularly neonates with acute, reversible respiratory conditions like meconium aspiration syndrome, often have better outcomes. Increasing age, especially for adults over 65, associates with lower hospital survival rates.
- Pre-existing Health Conditions (Comorbidities): Conditions like chronic cardiac failure, interstitial lung disease, and rheumatologic disease can decrease the likelihood of hospital discharge.
ECMO-Related Factors
- Reason for Support: Whether for respiratory failure, cardiac shock, or as a bridge to transplant, the specific reason affects survival.
- Type of ECMO: VV ECMO, typically used for isolated respiratory failure, often has better survival rates than VA ECMO, which supports both heart and lung function.
- Duration of Support: Survival statistics worsen when ECMO is required for more than three days.
- Complications: Bleeding, clotting, or infection are common and can negatively impact survival.
Long-Term Health and Quality of Life
After surviving ECMO and hospital discharge, patients often face a prolonged recovery with various health challenges. These challenges are commonly grouped under Post-Intensive Care Syndrome (PICS), encompassing new or worsening physical, cognitive, and psychological impairments. Physical issues are common, including muscle weakness and fatigue, which can persist for months and often require physical rehabilitation. Some patients may also have ongoing organ dysfunction, such as kidney or lung problems, requiring continued medical management.
Cognitive difficulties, such as memory problems, attention deficits, and “brain fog,” are frequently reported by survivors. These impairments can affect return to work or daily activities. Psychological impacts are significant, with survivors often experiencing anxiety, depression, and post-traumatic stress disorder (PTSD). While some patients achieve a good quality of life, a substantial portion requires ongoing support, including physical therapy, occupational therapy, and mental health counseling.