Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study

BACKGROUND: Long-term outcomes and quality of life have been identified as core patient-centered outcomes for venoarterial extracorporeal membrane oxygenation (VA-ECMO) research. The aim of this study is to investigate the incidence of death or new disability at 12 months after the initiation of VA-ECMO. METHODS: Prospective, multicenter, registry-embedded cohort study in 26 hospitals in Australia and New Zealand from February 2019 through April 2023. Adult patients admitted to a participating ICU and who underwent VA-ECMO were included. The primary outcome was death or new disability at 6 and 12 months. All results were adjusted for patient characteristics at the time of ECMO initiation. RESULTS: Among 389 patients who received VA-ECMO (median age, 57 [44-65] years; 35% female), the incidence of death or new disability at 12 months was 70.6% compared with 70.8% at 6 months (adjusted odds ratio for 12 versus 6 months, 0.61 [95% CI, 0.25-1.49]; P=0.27). Compared with 6 months, at 12 months after VA-ECMO more patients were independent in activities of daily living (62.1% versus 48.2%; adjusted odds ratio, 2.84 [95% CI, 1.50-5.36]; P=0.001), and fewer patients were unemployed due to health reasons (32.7% versus 47.4%; adjusted odds ratio, 0.29 [95% CI, 0.13-0.65]; P<0.001). Differences in outcomes were found according to the reason for VA-ECMO initiation. CONCLUSIONS: At 12 months after VA-ECMO, 30% of patients are alive and without disability, with differences in outcome associated with the reason for VA-ECMO initiation. The major burden of disability appears to develop in the first 6 months after VA-ECMO initiation and is sustained between 6 and 12 months.