Background

For over three decades ECMO-treatment has been provided in our low-volume nationwide cardiothoracic centre in Iceland. This research aims to examine both the short- and long-term results of all adult ECMO-cases at our centre, including health-related quality of life (HrQoL), return to work status and symptoms of post-traumatic stress disorder (PTSD).

Methods

A retrospective study including all adult patients treated with ECMO in a single university cardiothoracic centre in Iceland between 2002 and 2022. Five-year survival was evaluated with Kaplan-Meier estimates, HrQoL with the EQ-5D-5 L instrument and PTSD with the LEC and PLC-5 check lists assessing traumatic life events and PTSD symptoms, respectively. Median follow-up time was 6.5 yrs.

Results

Ninety-three patients received ECMO during the study period, an average of 5.2 patients per year since 2006. Sixty-six patients received venoarterial (VA) ECMO, of whom 28 (42%) could be weaned and 21 (32%) survived to discharge. Twenty-seven patients received venovenous (VV) ECMO, with 18 (67%) surviving to discharge. Twenty-four out of 30 living patients completed follow-up questionnaires. No problems with an EQ-5D-5L domain was reported 21 times in the VA ECMO group and 33 times in the VV ECMO group. Three out of four patients reported problems with anxiety or depression. Six patients (25%) met screening criteria for PTSD. At the end of follow-up, 2/12 VA ECMO and 8/12 VV ECMO patients had returned to work .

Conclusions

ECMO treatment can be provided with acceptable short- and long-term mortality in a low-volume centre. Nonetheless, opportunities for improvement could be identified, particularly regarding VA ECMO in cardiac arrest. At long-term follow-up, problems with anxiety and/or depression were most commonly observed and 25% met screening criteria for PTSD. Most VA ECMO surviors did not return to work.