HEALTH-RELATED QUALITY-OF-LIFE IN LONG-TE RM SURVIVORS AFTER TREATMENT WITH EXTRACORPOREAL MEMBRANE-OXYGENATION (ECMO) FOR THE ACUTE RESPIRATORY-DISTRESS SYNDROME (ARDS)

Treatment of severe acute respiratory distress syndrome (ARDS) with ex tracorporeal membrane oxygenation (ECMO) can be lifesaving but require s maximal use of intensive care resources over prolonged periods of ti me, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled re trospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy. Methods: 14 lon g-term survivors of ARDS (APACHE II score=24, Lung Injury Score=3.25, median values) treated using ECMO between 1992 and 1995 (median time i nterval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (gr oup I) were identified and completed the SF-36 Health Status Questionn aire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide n ormal values for the SF-36 in a German population. All three groups we re comparable with respect to sex and age. Results: Long-term survivor s of ECMO-therapy reported significant reductions in physical function ing when compared with patients treated by mechanical ventilation alon e (group I, -12.5%, p<0.05) and with healthy controls (group II, -50%, p<0.05) and showed a higher incidence of chronic physical pain (+5% a nd +24%, respectively, p<0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental he alth index or social functioning) between ECMO-patients and all contro ls. Nine patients (64.3%) from the ECMO group versus all patients trea ted conventionally (group I) had full-time employment (p=0.46, Chi(2) test). Conclusions: The majority of long-term survivors of ECMO-treatm ent show good physical and social functioning, including a high rate o f employment. The more aggressive approach of ECMO-therapy and a possi bly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to rea ch a highly satisfactory health-related quality of life.