Neurology

Long-term neuropsychiatric symptoms are common following ECMO: Meta-analysis

January 17, 2024

A substantial proportion of extracorporeal membrane oxygenation (ECMO) patients appear to experience neuropsychiatric symptoms and neurocognitive and functional impairments at long-term follow-up. This meta-analysis found that more than 10 tools were used to assess neuropsychiatric and neurocognitive outcomes, indicating a lack of standardization in assessment methodologies. Given the heterogeneity in methodology for gauging these outcomes, researchers concluded that further investigation and standardization is warranted.

• Databases were searched for text related to ECMO and neuropsychiatric, neurocognitive, and functional outcomes from inception to May 3, 2023. Primary outcome was the prevalence of neuropsychiatric symptoms at long-term (≥6 months) follow-up. Secondary outcomes were the prevalence of neurocognitive impairment, functional impairment, and favorable neurologic outcomes.
• In total, 59 studies with 3,280 patients (median age 54 years, 69% male) were included. 86% of the patients received venoarterial (VA)-ECMO (n = 2,819) and 14% received venovenous (VV)-ECMO (n = 461).
• Overall prevalence of neuropsychiatric symptoms was 41% (95% confidence interval [CI] 33%-49%). Symptoms included pain/discomfort (52%, 95% CI 42%-63%), sleep disturbance (37%, 95% CI 0%-98%), anxiety (36%, 95% CI 27%-46%), depression (31%, 95% CI 22%-40%), and PTSD (18%, 95% CI 9%-29%). 
• Prevalence of neurocognitive impairment was 38% (95% CI 13%-65%) and functional impairment was 52% (95% CI 40%-64%).
• Prevalence of neuropsychiatric symptoms in VV-ECMO patients was higher than that in VA-ECMO patients (55% [95% CI 34%-75%] vs 32% [95% CI 23%-41%], p = 0.01), though the prevalence of neurocognitive and functional impairment was similar between the groups.
• Prevalence of favorable neurologic outcomes was not different at various follow-ups: 3 months (23%, 95% CI 12%-36%), 6 months (25%, 95% CI 16%-35%), and ≥1 year (28%, 95% CI 21%-36%, p = 0.68).

Source:

Kalra A, et al for HERALD (Hopkins Education, Research, and Advancement in Life-support Devices). (2023, February 13). Neurology. Long-Term Neuropsychiatric, Neurocognitive, and Functional Outcomes of Patients Receiving ECMO. https://pubmed.ncbi.nlm.nih.gov/38181313/