Extracorporeal Membrane Oxygenation 1-yr Outcome: Reply

We thank Drs. Phillips and Fink for their interest in our work¹ and we completely agree with all their observations. Through the years, we have assisted with continuous significant advancements in the care of critically ill patients. Better management of mechanical ventilation and sepsis, advanced monitoring techniques, and more recently, extracorporeal life support techniques, all contributed to improve the rate of survival of critical illness. There is also a tendency to admit older patients with more comorbidities to intensive care units (ICU). At the same time, however, we are realizing that being discharged alive from ICU might not be “the last stage of the journey,” but rather, the beginning of an even longer and potentially more painful ordeal. Indeed, ICU survivors experience not only the direct consequences of the critical illness, but also significant long-term outcomes including physical weakness, neurocognitive impairment, and psychiatric disorders that, in turn, significantly affect their quality of life.²  Moreover, families and caregivers are also at increased risk for psychologic sequelae, particularly posttraumatic stress disorder. Hence, in critical patients, long-term mortality, morbidity, and quality of life may be considered more meaningful outcomes than short-term mortality.³ 

In our study,¹  acute respiratory distress syndrome survivors had almost full recovery of lung function, but severe impairment of quality of life, and stress, anxiety, depression, and posttraumatic stress disorder occurred with alarming frequency. Interestingly, patients treated with extracorporeal membrane oxygenation had a better health-related quality of life then those receiving conventional treatment. We acknowledge that the generalizability of our results is limited, since they come from a single-center study with significant methodologic limitations,⁵  conducted in a highly specialized tertiary referral center. For these reasons, our data do not prove that extracorporeal membrane oxygenation is “a mechanism for helping people recover closer to their baseline functional status,” but they provide a hypothesis for future research. We strongly believe that larger, multicenter, well-designed trials are necessary to understand the actual impact of extracorporeal membrane oxygenation support upon long-term outcomes. Moreover, from a clinical perspective, we believe that specialized multidisciplinary follow-up programs⁵  may allow the early recognition and treatment of physical and/or psychologic sequelae and can play a crucial role to improve the quality of life of patients recovering from critical illnesses.

Dr. Grasselli received payment for lectures from Thermo-Fisher (Waltham, Massachusetts) and Pfizer Pharmaceuticals (New York, New York) and travel, accommodation, and congress registration support from Biotest (Dreieich, Germany; all these relationships are unrelated with the current work). The other authors declare no competing interests.