“We suspected ECMO survivors would be at greater risk of mental health impacts because they are sedated and ventilated for longer and often face a more challenging recovery. But we didn’t have clear data until now."- Dr. Shannon FernandoSurvivors of ECMO life support had a 24% higher rate of new mental health diagnoses after discharge compared to other ICU survivors, according to the first study of its kind, published in JAMA.
ECMO, or extracorporeal membrane oxygenation, is the most advanced form of life support. It temporarily replaces the heart and lungs of patients suffering from heart or respiratory failure. This resource-intensive treatment is usually reserved for younger, healthier patients who are most likely to survive. This is the first study to look at how their mental health is affected.
“ECMO saves lives. About 50 to 65% of patients who receive this treatment will survive, and most are alive five years later,” said Dr. Shannon Fernando, a critical care physician at Lakeridge Health and postdoctoral fellow at The Ottawa Hospital and the University of Ottawa. “We already knew that ICU survivors can suffer mental health impacts from the trauma of invasive treatments, living with new physical limitations and dealing with long recovery times. We suspected ECMO survivors would be at greater risk of mental health impacts because they are sedated and ventilated for longer and often face a more challenging recovery. But we didn’t have clear data until now.”
To find out, the team of researchers from The Ottawa Hospital, the Institut du Savoir Montfort, ICES and the University of Ottawa looked at health records from all ICU survivors in Ontario, Canada from April 2010 to March 2020.
The researchers matched the 642 ECMO survivors with 3,820 other ICU survivors who had similar characteristics including age, sex, mental health history, critical illness severity and hospital length of stay. This analysis found ECMO patients had a 24% higher rate of new mental health diagnoses compared with other ICU survivors.
Of the 642 ECMO survivors, 236 (37%) were diagnosed with a new mental health condition. The most frequent diagnoses were depression, anxiety, and mental health conditions caused by a traumatic experience, known as traumatic disorders. Previous studies have found these to be the most common mental health diagnoses among survivors of critical illness.
“As care providers, we can tell our patients that it’s common to struggle with your mental health after an ICU admission,” said Dr. Peter Tanuseputro, co-senior author, physician-scientist at The Ottawa Hospital and ICES, investigator at the Bruyère Research Institute and associate professor at the Department of Medicine, University of Ottawa. “ICU survivors need to realize that they often face months or years of recovery, and families and healthcare providers need to support them.”
This study’s findings are particularly relevant during the COVID-19 pandemic, as the use of ECMO grew worldwide to address never-before-seen numbers of patients with severe respiratory failure. At the height of the pandemic, the province of Ontario had twice as many patients on ECMO as it did pre-pandemic.
“We suddenly have a lot more ECMO survivors because of COVID-19. We need to make sure they have the mental health support they need to recover and thrive.” said Dr. Kwadwo Kyeremanteng, co-senior author on the paper and scientist and critical care physician at The Ottawa Hospital, senior clinician investigator at the Institut du Savoir Montfort and assistant professor at the University of Ottawa.
The research team recently received a research grant from the Montfort Alternate Funding Plan to test a virtual treatment program for post-ICU syndrome, a collection of physical, mental and emotional symptoms that persist after an ICU admission. The program will offer mental health services, physical therapy, and advice from nutritionists in an attempt to centralize services and take pressure off primary care providers and Emergency Departments.
The exact reasons why ECMO survivors are at greater risk of mental health problems compared to other ICU survivors is still unclear, and more research is needed.
“We really need more research and investment in the area of post-critical illness,” said Dr. Fernando. “Patients will need help long after they leave the ICU.”
Reference: Association of Extracorporeal Membrane Oxygenation with New Mental Health Diagnoses in Adult Survivors of Critical Illness. Shannon M. Fernando, Mary Scott, Robert Talarico, Eddy Fan, Daniel I. McIsaac, Manish M. Sood, Daniel T. Myran, Margaret S. Herridge, Dale M. Needham, Carol L. Hodgson, Bram Rochwerg, Laveena Munshi, M. Elizabeth Wilcox, O. Joseph Bienvenu, Graeme MacLaren, Robert A. Fowler, C. Scales, Niall D. Ferguson, Alain Combes, Arthur S. Slutsky, Daniel Brodie, Peter Tanuseputro, Kwadwo Kyeremanteng. JAMA. October 26, 2022.
Funding: This study was funded by the Institut du Savoir Montfort. Research at The Ottawa Hospital is enabled by generous donations to The Ottawa Hospital Foundation.
Data sources: ICES and the Canadian Institute for Health Information
About The Ottawa Hospital
The Ottawa Hospital is one of Canada’s top learning and research hospitals, where excellent care is inspired by research and driven by compassion. As the third-largest employer in Ottawa, our support staff, researchers, nurses, physicians, and volunteers never stop seeking solutions to the most complex health-care challenges. Our multi-campus hospital, affiliated with the University of Ottawa, attracts some of the most influential scientific minds from around the world. Backed by generous support from the community, we are committed to providing the world-class, compassionate care we would want for our loved ones. www.ohri.ca
About Institut du Savoir Montfort
Created in 2015, the Institut du Savoir Montfort (ISM) is a non-profit organization that aims to improve health and the world's health by combining research and education. The ISM relies on collaboration between researchers, educators and andragogues, which facilitates the continuum creation-transmission of knowledge in the organization of health services and the prevention, screening and treatment of physical and mental co-morbidities.
About the University of Ottawa
The University of Ottawa is home to over 50,000 students, faculty and staff, who live, work and study in both French and English. Our campus is a crossroads of cultures and ideas, where bold minds come together to inspire game-changing ideas. We are one of Canada’s top 10 research universities—our professors and researchers explore new approaches to today’s challenges. One of a handful of Canadian universities ranked among the top 200 in the world, we attract exceptional thinkers and welcome diverse perspectives from across the globe. www.uottawa.ca
About ICES
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
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