# Survival and recovery: 24-month outcomes for critically Ill COVID-19 patients receiving ECMO

## TL;DR

This study examines long-term health and quality of life in COVID-19 patients who received ECMO, finding both recovery and unexpected complications.

## Contribution

The study provides novel 24-month follow-up data on ECMO-treated COVID-19 survivors, revealing long-term physiological and psychological outcomes.

## Key findings

- ECMO survivors showed persistent pulmonary fibrosis but normal lung function.
- Immune responses remained elevated in ECMO patients compared to controls.
- Long-term complications included depression, sleepiness, and reduced physical activity.

## Abstract

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) was used for patients with severe COVID-19 pneumonia. The aim of our study was to assess the long-term outcomes and quality of life of the surviving patients.

This single-center observational study was performed among patients who were discharged after V-V ECMO treatment with COVID-19 pneumonia. During the 2-year follow-up period, different organ functions and quality of life parameters were evaluated three times after discharge. As a control group, SARS-CoV-2 infection positive patients were included.

Thirty-five patients underwent V-V ECMO treatment, of whom 11 patients survived. The study population consists of 9 patients for the follow-up (2 patients did not consent to follow-up examinations). On lung CT, the occurrence of residual fibrotic banding was 22% at discharge, and increased to 89% at 24th month follow-up, while lung function tests were normal. On echocardiography, patients had a mildly elevated right ventricle end-diastolic diameter at the post discharge period, which normalized during follow-up (baseline: 37.6 ± 2.9 mm, follow-up: 35.6 ± 2.2 mm, p < 0.05). In the ECMO group both humoral and cellular immune responses remained elevated (Quantiferon Ag1 p = 0.005, Quantiferon Ag2 p = 0.0059, Quantiferon Ag3 p = 0.0012, IgG Roche p = 0.0037).

Among the psychological factors, significant correlation was observed between ECMO duration and symptoms of depression (r = 0.727; p < 0.05), anxiety (r = 0.848; p < 0.01), and posttraumatic stress (r = 0.834; p < 0.01), furthermore, a negative correlation with positive affectivity (r = −0.868; p < 0.01) presented itself. SF-36 scores improved significantly from the 6-month to the 24-month follow-up (median 50% vs. 80%, p < 0.01). The mean body mass index increased from 29 to 35 (kg/m2) and physical activity decreased. The Epworth Sleepiness Scale showed higher normal daytime sleepiness values and elevated Fatigue Severity Scale scores.

At the 2-year follow-up after discharge from the V-V ECMO treatment, permanent cardio muscular and structural pulmonary damage had been anticipated. However, on one hand, good cardiac and pulmonary function and robust sustained immune response were measured. On the other hand, unforeseen long-term complications arose, such as sleepiness, reduced physical activity, acute depression, and consequently, a deteriorated health related quality of life. These findings highlight the necessity of long-term, structured controlled rehabilitation programs for this patient population.

Line charts compare fold change over time for ECMO and control groups across four panels: Ag1, Ag2, and Ag3 QuantiFERON, and IgG Roche. Red lines represent ECMO and black lines represent control. Both groups show changes post-vaccination at six months, with ECMO consistently having higher values than control throughout the 30-month follow-up. Error bars indicate variability in data.