Extracorporeal Membrane Oxygenation (ECMO) use is associated with substantial psychiatric morbidity in patients and their families. This systematic review and meta-analysis quantifies the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression among ECMO survivors and their families. Included studies enrolled patients on ECMO or their families and reported at least one trauma-related psychopathology. Of 1767 screened studies, 55 were included (5146 participants): 50 in adult ECMO survivors, one in pediatric ECMO survivors, and four in families of ECMO patients (two adult, two pediatric.). The pooled prevalence of PTSD was 19% in adult ECMO survivors, 20% in pediatric ECMO survivors, 25% in families of adult ECMO patients, and 21% in families of pediatric ECMO patients. The pooled prevalence of anxiety was 30% in adult ECMO survivors, 8% in pediatric ECMO survivors, 67% in families of adult ECMO patients, and 46% in families of pediatric ECMO patients. The pooled prevalence of depression was 24% in adult ECMO survivors, 8% in pediatric ECMO survivors, 50% in families of adult ECMO patients, and 32% in families of pediatric ECMO patients. This meta-analysis demonstrates a high prevalence of trauma-related psychopathologies surrounding ECMO use, highlighting the need for interventions to improve post-ECMO outcomes.
WintermannG-BWeidnerKStraußB, et al.Predictors of posttraumatic stress and quality of life in family members of chronically critically ill patients after intensive care. Ann Intensive Care2016; 6: 69.
3.
DavydowDSGiffordJMDesaiSV, et al.Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatr2008; 30: 421–434.
4.
HoffmannMJeitzinerM-MRiedlR, et al.Effects of an online information tool on post-traumatic stress disorder in relatives of intensive care unit patients: a multicenter double-blind, randomized, placebo-controlled trial (ICU-Families-Study). Intensive Care Med2023; 49: 1317–1326.
5.
DupontTKentish-BarnesNPochardF, et al.Prediction of post-traumatic stress disorder in family members of ICU patients: a machine learning approach. Intensive Care Med2024; 50: 114–124.
6.
CameronJIChuLMMatteA, et al.One-year outcomes in caregivers of critically ill patients. N Engl J Med2016; 374: 1831–1841.
7.
KanjiHDChouldechovaAHarris-FoxS, et al.Quality of life and functional status of patients treated with venovenous extracorporeal membrane oxygenation at 6 months. J Crit Care2021; 66: 26–30.
8.
NellisMEDaltonHKaramOPediECMO Investigators. Quantifiable bleeding in children supported by extracorporeal membrane oxygenation and outcome. Crit Care Med2019; 47: E886–E892.
9.
RileyARWilliamsCNMoyerD, et al.Parental posttraumatic stress symptoms in the context of pediatric post-intensive care syndrome: impact on the family and opportunities for intervention. Clin Pract Pediatr Psychol2021; 9: 156–166.
10.
WoolfCMuscaraFAndersonVA, et al.Early traumatic stress responses in parents following a serious illness in their child: a systematic review. J Clin Psychol Med Settings2016; 23: 53–66.
11.
NelsonLPGoldJI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med2012; 13: 338–347.
12.
ManningJCPintoNPRennickJE, et al.Conceptualizing post intensive care syndrome in children—the PICS-p framework*. Pediatr Crit Care Med2018; 19: 298–300.
13.
NeedhamDMDavidsonJCohenH, et al.Improving long-term outcomes after discharge from intensive care unit: report from a stakeholdersʼ conference*. Crit Care Med2012; 40: 502–509.
14.
WatsonRSChoongKColvilleG, et al.Life after critical illness in children—toward an understanding of pediatric post-intensive care syndrome. J Pediatr2018; 198: 16–24.
15.
MoherDLiberatiATetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ2009; 339: b2535.
16.
HaydenJAvan der WindtDACartwrightJL, et al.Assessing bias in studies of prognostic factors. Ann Intern Med2013; 158: 280–286.
17.
BarendregtJJDoiSALeeYY, et al.Meta-analysis of prevalence. J Epidemiol Community Health2013; 67: 974–978.
18.
DerSimonianRKackerR. Random-effects model for meta-analysis of clinical trials: an update. Contemp Clin Trials2007; 28: 105–114.
19.
LauJIoannidisJPSchmidCH. Quantitative synthesis in systematic reviews. Ann Intern Med1997; 127: 820–826.
20.
SterneJACSuttonAJIoannidisJPA, et al.Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ2011; 343: d4002.
21.
OnrustMLansink-HartgringAOvan der MeulenI, et al.Coping strategies, anxiety and depressive symptoms in family members of patients treated with extracorporeal membrane oxygenation: a prospective cohort study. Heart Lung2022; 52: 146–151.
22.
GrasselliGScaravilliVTubioloD, et al.Quality of life and lung function in survivors of extracorporeal membrane oxygenation for acute respiratory distress syndrome. Anesthesiology2019; 130: 572–580.
23.
WadiaTChan-DominyAMcGuckianJ, et al.Impact of the coronavirus (COVID-19) pandemic on care and rehabilitation of children who survived extracorporeal membrane oxygenation (ECMO). Pediatr Crit Care Med2021; 22: 252–253.
24.
SampsonCHarris-FoxS. Single centre experience of post-traumatic stress symptoms in adult ECMO survivors-prevalence and risk factors. Eur J Heart Fail2017; 19: 47.
25.
SadlonovaMSchwarzbauerLGereckeB, et al.Health-related quality of life, psychological symptoms, resilience, and spirituality in ECMO survivors and their family members. Psychosom Med2022; 84: A15.
26.
MirabelMLuytCELeprinceP, et al.Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med2011; 39: 1029–1035.
27.
McDonaldBAHeatherBRigstadB, et al.A comparison of quality of life in COVID versus non-COVID patients requiring VV-ECMO. Am J Respir Crit Care Med2022; 205: A1523.
28.
MakoudiSGentonABernardR, et al.Outcome, long-term quality-of-life, physical and psychological assessment of patients supported by extracorporeal life support (ECLS) for postcardiotomy refractory cardiogenic shock. Ann Intensive Care2017; 7: 159–160.
29.
LuytCECombesARichardJCM, et al.Long-termoutcomeof survivorsof acute respiratory distress syndrome (ARDS) due to pandemic 2009 influenza a (H1N1) virus infection: the respiflu study. Intensive Care Med2011; 37: S287.
30.
LatifiMChenLHuaV, et al.Ecmo survivors clinic: assessment of psychologic and pulmonary function in VV ECMO survivors. Crit Care Med2022; 50: 226.
31.
FrisenG. Lived experience of memories and post traumatic stress in adult patients after extracorporeal membrane oxygenation: a follow-up program. Perfusion2020; 35: 155.
32.
BiedermanSWeiler-LisowskiBKumarA, et al.Psychological morbidity in family members of patients receiving extracorporeal membrane oxygenation. Crit Care Med2018; 46: 409.
33.
BermudezCANorihisaSDianaZ, et al.Contemporary outcomes of lung transplantation using extracorporeal membrane oxygenation as bridge. J Heart Lung Transplant2013; 32: S266.
34.
AubinHEschlbockSRelleckeP, et al.Organ recovery and functional status in survivors of ecls therapy for cardiogenic shock. Thorac Cardiovasc Surg2019; 67.
35.
AmsallemMBouclyABrechotN, et al.Two years outcomes of influenza a (H1N1)-associated acute respiratory distress syndrome survivors treated by extracorporeal membrane oxygenation. Intensive Care Med2013; 39: S305.
36.
AbdelazizMMFowlesJVulystekeA, et al.Medium term impacts of ECMO on adult survivors. Thorax2016; 71: A190–A192.
37.
von BahrVKalzenHFrencknerB, et al.Long-term pulmonary function and quality of life in adults after extracorporeal membrane oxygenation for respiratory failure. Perfusion (United Kingdom)2019; 34: 49–57.
38.
TrammRIlicDSheldrakeJ, et al.Recovery, risks, and adverse health outcomes in year 1 after extracorporeal membrane oxygenation. Am J Crit Care2017; 26: 311–319.
39.
SylvestreAAddaMMalteseF, et al.Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients. Ann Intensive Care2019; 9: 82.
40.
StadlbauerAPhilippABlechaS, et al.Long-term follow-up and quality of life in patients receiving extracorporeal membrane oxygenation for pulmonary embolism and cardiogenic shock. Ann Intensive Care2021; 11: 181.
41.
SchmidtMZogheibERozeH, et al.The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. Intensive Care Med2013; 39: 1704–1713.
42.
SanfilippoFIppolitoMSantonocitoC, et al.Long-term functional and psychological recovery in a population of acute respiratory distress syndrome patients treated with VV-ECMO and in their caregivers. Minerva Anestesiol2019; 85: 971–980.
43.
RuckertFSteinkeTFlotherL, et al.Predictors for quality of life of patients with a portable out-of-centre-implanted extracorporeal membrane oxygenation device. Interact Cardiovasc Thorac Surg2017; 24: 542–548.
44.
RossongHDebreuilSYanW, et al.Long-term survival and quality of life after extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg2023; 166: 555–566.e2.
45.
RollMAKuysSWalshJR, et al.Long-term survival and health-related quality of life in adults after extra corporeal membrane oxygenation. Heart Lung Circ2019; 28: 1090–1098.
46.
RisnesIHeldalAWagnerK, et al.Psychiatric outcome after severe cardio-respiratory failure treated with extracorporeal membrane oxygenation: a case-series. Psychosomatics2013; 54: 418–427.
47.
RilingerJKrotzschKBemtgenX, et al.Long-term survival and health-related quality of life in patients with severe acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation support. Crit Care2021; 25: 410.
48.
RajajeeVFungCM-CSeaglyKS, et al.One-year functional, cognitive, and psychological outcomes following the use of extracorporeal membrane oxygenation in coronavirus disease 2019: a prospective study. Crit Care Explor2021; 3: e0537.
49.
PozziMGianiMAndreossiM, et al.Long-term physical, cognitive, and psychological outcomes in severe COVID-19 patients managed with extracorporeal membrane oxygenation: a prospective study. Am Soc Artif Intern Organs J2023; 69: E376–E383.
50.
PladetLCALuijkenKDonkerDW, et al.Neuropsychiatric sequelae following extracorporeal membrane oxygenation in the intensive care unit. J Crit Care2024; 79: 154428.
51.
ParkHYChoHWSongIA, et al.Long-term mortality associated with depression among South Korean survivors of extracorporeal membrane oxygenation. Brain Behav2021; 11: e02218.
52.
OrboMCKarlsenSFPedersenEP, et al.Health-related quality of life after extracorporeal membrane oxygenation: a single centre’s experience. ESC Heart Failure2019; 6: 701–710.
53.
O’BrienSGCartonEGFealyGM. Long-term health-related quality of life after venovenous extracorporeal membrane oxygenation. Am Soc Artif Intern Organs J2020; 66: 580–585.
54.
NorkieneIJovaisaTScupakovaN, et al.Long-term quality of life in patients treated with extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Perfusion (United Kingdom)2019; 34: 285–289.
55.
MullerGFlecherELebretonG, et al.The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med2016; 42: 370–378.
56.
MostafaAMHAMTuttleCJMcKieMA, et al.Predictors of health-related quality of life in patients undergoing extracorporeal membrane oxygenation for acute severe respiratory failure. J Intensive Care Soc2023; 24: 283–291.
57.
McDonaldMDLane-FallMMianoTA, et al.The effect of sedation on long-term psychological impairment after extracorporeal life support. J Cardiothorac Vasc Anesth2020; 34: 663–667.
58.
MarshLCLeachRMBlaneJ, et al.Long-term cognitive and psychiatric outcomes of acute respiratory distress syndrome managed with Extracorporeal Membrane Oxygenation. Respir Med2021; 183: 106419.
59.
LucchiniAVillaMGianiM, et al.Long term outcome in patients treated with veno-venous extracorporeal membrane oxygenation: a prospective observational study. Intensive Crit Care Nurs2024; 82(9): 103631.
60.
LinWJChangYLWengLC, et al.Post-Discharge depression status for survivors of extracorporeal membrane oxygenation (ECMO): comparison of veno-venous ECMO and veno-arterial ECMO. Int J Environ Res Publ Health2022; 19: 3333.
61.
KolleAIrgensECMoiAL, et al.The psychological and HRQoL related aftermaths of extra corporeal membrane oxygenation treatment: a cross-sectional study. Intensive Crit Care Nurs2021; 65: 103058.
62.
ImmohrMBEschlbockSMRelleckeP, et al.The quality of afterlife: surviving extracorporeal life support after therapy-refractory circulatory failure-a comprehensive follow-up analysis. ESC Heart Fail2021; 8: 4968–4975.
63.
HarleyOReynoldsCNairP, et al.Long-term survival, posttraumatic stress, and quality of life post extracorporeal membrane oxygenation. Am Soc Artif Intern Organs J2020; 66: 909–914.
64.
GuentherSPWHornungRJoskowiakD, et al.Extracorporeal life support in therapy-refractory cardiocirculatory failure: looking beyond 30 days. Interact Cardiovasc Thorac Surg2021; 32: 607–615.
65.
GuentherSPWCheabanRHoepnerL, et al.Functional status and quality of life 6 Months after extracorporeal membrane oxygenation therapy for COVID-19-related pulmonary failure. Am Soc Artif Intern Organs J2023; 69: 942–949.
66.
GalazziABrambillaAGrasselliG, et al.Quality of life of adult survivors after extra corporeal membrane oxygenation (ECMO): a quantitative study. Dimens Crit Care Nurs2018; 37: 12–17.
67.
GalasFRBGFernandesHMFranciA, et al.In-hospital and post-discharge status in COVID-19 patients with acute respiratory failure supported with extracorporeal membrane oxygenation. Am Soc Artif Intern Organs J2023; 69: E181–E187.
68.
de VlugtRSpekBvan de PolI, et al.Quality of life after extra corporeal life support therapy. Perfusion (United Kingdom)2023; 38: 1189–1195.
69.
ChommelouxJValentinSWiniszewskiH, et al.One-year mental and physical health assessment in survivors after extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome. Am J Respir Crit Care Med2023; 207: 150–159.
70.
ChenKHLeePSTsaiFC, et al.Health-related outcomes of extracorporeal membrane oxygenation in adults: a cross-sectional study. Heart Lung2022; 52: 76–85.
71.
ChenKHChenYTYehSL, et al.Changes in quality of life and health status in patients with extracorporeal life support: a prospective longitudinal study. PLoS One2018; 13: e0196778.
72.
Alonso-Fernandez-GattaMGonzalez-CebrianMMerchan-GomezS, et al.Post-traumatic stress disorder symptoms after veno-arterial extracorporeal membrane oxygenator support. Heart Lung2021; 50: 775–779.
73.
BrownKLMoinuddinMJonesA, et al.The relationship between postoperative complications and children’s quality of life: a mediation analysis to explore the role of family factors. Pediatr Crit Care Med2023; 24: 194–203.
74.
LewisARWrayJO’CallaghanM, et al.Parental symptoms of posttraumatic stress after pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med2014; 15: e80–e88.
75.
NaPJSchnurrPPPietrzakRH. Mental health of U.S. combat veterans by war era: results from the National health and Resilience in veterans study. J Psychiatr Res2023; 158: 36–40.
76.
HuangMParkerAMBienvenuOJ, et al.Psychiatric symptoms in acute respiratory distress syndrome survivors: a 1-year national multicenter study. Crit Care Med2016; 44: 954–965.
77.
YaowCYLTeohSELimWS, et al.Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: a systematic review and meta-analysis. Resuscitation2022; 170: 82–91.
78.
AndersenSKButlerRAChangC-CH, et al.Prevalence of long-term decision regret and associated risk factors in a large cohort of ICU surrogate decision makers. Crit Care2023; 27: 61.
79.
WendlerDRidA. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med2011; 154: 336–346.
80.
MillerJJMorrisPFilesDC, et al.Decision conflict and regret among surrogate decision makers in the medical intensive care unit. J Crit Care2016; 32: 79–84.
81.
AshworthRCMaloneJRFranklinD, et al.Associations of patient and parent characteristics with parental decision regret in the PICU: a secondary analysis of the 2015–2017 navigate randomized comparative trial. Pediatr Crit Care Med2024; 25: 795–803.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
