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Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients.

ABSTRACT: BACKGROUND:Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with a significant morbidity. There is the need to investigate long-term cognitive outcome among ARDS survivors treated with VV-ECMO. We aimed to compare the prevalence of long-term cognitive dysfunction and neuropsychological impairment using a highly specific test in severe ARDS survivors treated or not treated with VV-ECMO. METHODS:Severe ARDS survivors treated between 2011 and 2017 in an ECMO Regional Referral Center were prospectively evaluated 2 years after their ICU discharge. Patients underwent an in-person interview and examination. The primary outcome was cognitive function, assessed by the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). Secondary outcomes included anxiety, depression, post-traumatic stress disorder (PTSD) and quality-of-life. RESULTS:We investigated 40 consecutive patients surviving from severe ARDS treated (N?=?22) or not (N?=?18) with VV-ECMO at a median [interquartile range] of 20 [17-22] and 22 [18-23] months after ICU discharge, respectively. Regarding the main outcome, cognitive function was below normal ranges in 12 (55%) ECMO patients and 10 (56%) non-ECMO patients (p?=?0.95). Eight (36%) ECMO patients had moderate-to-severe depressive symptoms as compared with 7 (39%) non-ECMO patients (p?=?0.87). Twelve (55%) ECMO patients and eight (44%) non-ECMO patients had moderate-to-severe anxiety symptoms (p?=?0.53). Seven (33%) ECMO patients and eight (44%) non-ECMO patients presented a PTSD (p?=?0.48). Health-related quality of life did not differ between the two groups. CONCLUSIONS:Using the WAIS-IV, VV-ECMO treatment does not appear to worsen long-term cognitive and neuropsychological outcomes in severe ARDS patients.

SUBMITTER: Sylvestre A

PROVIDER: S-EPMC6635548 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients.

Sylvestre Aude A Adda Mélanie M Maltese François F Lannelongue Ariane A Daviet Florence F Parzy Gabriel G Coiffard Benjamin B Roch Antoine A Loundou Anderson A Baumstarck Karine K Papazian Laurent L

Annals of intensive care 20190716 1

<h4>Background</h4>Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with a significant morbidity. There is the need to investigate long-term cognitive outcome among ARDS survivors treated with VV-ECMO. We aimed to compare the prevalence of long-term cognitive dysfunction and neuropsychological impairment using a highly specific test in severe ARDS survivors treated or not treated with VV-ECMO.<h4>Methods</h4>Severe ARDS survivors treated between 2011 and 2017 in an ECMO Reg ...[more]

PMID: 31312911

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Project description:BACKGROUND:Herpesviridae reactivation among non-immunocompromised critically ill patients is associated with impaired prognosis, especially during acute respiratory distress syndrome (ARDS). However, little is known about herpes simplex virus (HSV) and Cytomegalovirus (CMV) reactivation occurring in patients with severe ARDS under veno-venous extracorporeal membrane oxygenation (ECMO). We tried to determine the frequency of Herpesviridae reactivation and its impact on patients' prognosis during ECMO for severe ARDS. RESULTS:During a 5-year period, 123 non-immunocompromised patients with a severe ARDS requiring a veno-venous ECMO were included. Sixty-seven patients (54%) experienced HSV and/or CMV reactivation during ECMO course (20 viral co-infection, 40 HSV alone, and 7 CMV alone). HSV reactivation occurred earlier than CMV after the beginning of MV [(6-15) vs. 19 (13-29) days; p?<?0.01] and after ECMO implementation [(2-8) vs. 14 (10-20) days; p?<?0.01]. In univariate analysis, HSV/CMV reactivation was associated with a longer duration of mechanical ventilation [(22-52.5) vs. 17.5 (9-28) days; p?<?0.01], a longer duration of ECMO [15 (10-22.5) vs. 9 (5-14) days; p?<?0.01], and a prolonged ICU [29 (19.5-47.5) vs. 16 (9-30) days; p?<?0.01] and hospital stay [44 (29-63.5) vs. 24 (11-43) days; p?<?0.01] as compared to non-reactivated patients. However, in multivariate analysis, viral reactivation remained associated with prolonged MV only. When considered separately, both HSV and CMV reactivation were associated with a longer duration of MV as compared to non-reactivation patients [29 (19.5-41) and 28 (20.5-37), respectively, vs. 17.5 (9-28) days; p?<?0.05]. Co-reactivation patients had a longer duration of MV [58.5 (38-72.3); p?<?0.05] and ICU stay [51.5 (32.5-69) vs. 27.5 (17.75-35.5) and 29 (20-30.5), respectively] as compared to patients with HSV or CMV reactivation alone. In multivariate analysis, HSV reactivation remained independently associated with a longer duration of MV and hospital length of stay. CONCLUSIONS:Herpesviridae reactivation is frequent among patients with severe ARDS under veno-venous ECMO and is associated with a longer duration of mechanical ventilation. The direct causative link between HSV and CMV reactivation and respiratory function worsening under ECMO remains to be confirmed.

Dataset Information

Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients.

Publications

Long-term neurocognitive outcome is not worsened by of the use of venovenous ECMO in severe ARDS patients.

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