A study led by the Vall d’Hebron Research Institute (VHIR)
A study led by the Vall d’Hebron Research Institute (VHIR) has shown that keeping awake patients connected to ECMO, a machine that temporarily replaces the lung, improves their subsequent recovery compared to those who are sedated.
Extracorporeal membrane oxygenation (ECMO) is a technique that aids the survival of patients with respiratory dysfunction in intensive care units. The machine replaces the function of the lungs when they no longer work autonomously, in order to give them a break and the opportunity to recover from the pathology they suffer from, such as an infection. It is a complex procedure and the most severe cases may require ECMO for even months, periods during which, in many cases, patients are sedated.
Improved prognosis
A multicenter study led by the VHIR Shock, Organ Dysfunction, and Resuscitation research group has shown that keeping ECMO patients awake, active, and rehabilitated can improve prognosis. The study, published in the journal Annals of the American Thoracic Society, was carried out in collaboration with the Pitié-Salpêtrière Hospital in Paris, the Karolinska Institute in Stockholm and the São João University Hospital in Porto.
Awakening and rehabilitating patients with severe respiratory dysfunction on ECMO helps with recovery and improves survival. They are the results of work led by the Vall d’Hebron Research Institute.
Benefits of ECMO
Since the beginning of the pandemic, Vall d’Hebron has used ECMO in more than 125 patients with covid-19, who were often sedated. However, even if their lungs do not work, it is possible to wake them up and do active rehabilitation because ECMO allows gas exchange to be carried out as in breathing; in addition, it can be adjusted based on the needs of each patient at each moment and increased while exercising. This can improve the prognosis of patients.
Survival and rehabilitation
A study of 120 patients with covid-19 respiratory dysfunction requiring ECMO for more than 28 days showed that among patients who were cooperative and had rehabilitation and physical therapy at some point during ECMO support, survival at six months was 78.8% and required less rehabilitation after discharge. In contrast, survival dropped to 41.4% in the most inactive and sedated cases.
Benefits of being awake
Being awake allows patients to interact with their family members, improve communication with healthcare professionals and help minimize complications such as infections and lung damage associated with ventilation. In addition, patients may experience cognitive and emotional benefits.
Factors that influence the prognosis
The study also noted that younger patient age favors survival. It should be noted that only patients who were on ECMO for more than 28 days and who had a prospect of improvement participated in the analysis.