BACKGROUND: This single center study analyzed epidemiology, outcomes, and three-year quality of life (QoL) of critically ill COVID-19 patients requiring a possibly life-saving VV-ECMO.

METHODS: Demographics, clinical and technical data from adult critical COVID-19 VV-ECMO patients were prospectively analyzed (March 2020-January 2022). QoL was yearly assessed by the ‘Medical Outcomes Study 36-item Short Form Health Survey’ (SF-36) questionnaire. Hospital Anxiety and Depression Scales were measured. Return to work (RTW) was monitored. Multivariate linear regression analyzed factors influencing SF-36 physical (PCS) and mental component summary (MCS) scores.

RESULTS: Forty-eight patients were included, median age was 51 [42.8-57.2] years. Clinical Frailty Scores were 1(33%), 2(44%) or 3(23%). At ECMO initiation, median SOFA score was 11.0 [9.0-12.0]. ECMO support lasted for a median duration of 16 [11.8-28.8] days. Median ICU and hospital stay was 32.0 [21.0-45.0] and 67.0 [58.0-130.0] days. One-year mortality was 33.3% without additional mortality after three years. PCS scores were lower than in general healthy population at one (P<0.001), two (P=0.037) and three (P<0.010) years. MCS scores were equivalent and higher at three years (P=0.015). Anxiety was present in 10/29 (34.5%) and 4/29 (13.8%) had symptoms of depression three years after ECMO initiation. RTW was possible in 13 out of 23 (56,5%), working prior to critical COVID-19.

CONCLUSIONS: Three-year mortality after VV-ECMO for critical COVID-19 was 33.3%. Physical health was impaired, but mental health remained comparable to the general population, with relatively low anxiety and depression levels. RTW was possible in 56.5%.