Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study.

IF 8.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Heart Failure Pub Date : 2025-06-01 Epub Date: 2025-04-29 DOI:10.1161/CIRCHEARTFAILURE.124.012476

Ary Serpa Neto, Alisa M Higgins, Michael J Bailey, Shannah Anderson, Stephen Bernard, Bentley J Fulcher, Annalie Jones, Natalie J Linke, Jasmin V Board, Daniel Brodie, Heidi Buhr, Aidan J C Burrell, D James Cooper, Eddy Fan, John F Fraser, David J Gattas, Ingrid K Hopper, Sue Huckson, Edward Litton, Shay P McGuinness, Priya Nair, Neil Orford, Rachael L Parke, Vincent A Pellegrino, David V Pilcher, Craig Dicker, Benjamin A J Reddi, Dion Stub, Tony V Trapani, Andrew A Udy, Carol L Hodgson

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引用次数: 0

Abstract

Background: Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO.

Methods: Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation.

Results: Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% women), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; P=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; P=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; P<0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation.

Conclusions: At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03793257.

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成人VA-ECMO术后前12个月的远期功能结局：一项前瞻性多中心研究

背景：长期预后和生活质量已被确定为静脉动脉体外膜氧合（VA-ECMO）研究中以患者为中心的核心结果。本研究的目的是调查VA-ECMO开始后12个月死亡或新残疾的发生率。方法：2019年2月至2023年4月，在澳大利亚和新西兰的26家医院进行前瞻性、多中心、注册嵌入队列研究。纳入了参与ICU并接受VA-ECMO的成年患者。主要结局是6个月和12个月时死亡或新的残疾。所有结果都根据ECMO开始时的患者特征进行了调整。结果：389例接受VA-ECMO的患者(中位年龄57岁[44-65]；35%女性)，12个月时死亡或新残疾的发生率为70.6%，而6个月时为70.8%(12个月对6个月的校正优势比为0.61 [95% CI, 0.25-1.49]；P = 0.27)。与6个月相比，在VA-ECMO后12个月，更多的患者能够独立进行日常生活活动(62.1% vs 48.2%；校正优势比为2.84 [95% CI, 1.50-5.36]；P=0.001)，因健康原因失业的患者较少(32.7%比47.4%；校正优势比，0.29 [95% CI, 0.13-0.65]；结论：在VA-ECMO后12个月，30%的患者存活且无残疾，结果的差异与VA-ECMO开始的原因有关。主要的残疾负担似乎在VA-ECMO开始后的前6个月出现，并持续6至12个月。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT03793257。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Heart Failure 医学-心血管系统

CiteScore

12.90

自引率

3.10%

发文量

271

审稿时长

6-12 weeks

期刊介绍： Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.