The Effect of Sedation on Long-Term Psychological Impairment After Extracorporeal Life Support

• Published in: Journal of cardiothoracic and vascular anesthesia 2020-03, Vol.34 (3), p.663-667
• Main Authors: McDonald, Michael D., Lane-Fall, Meghan, Miano, Todd A., Henry, Madeline, Gallagher, Colby, Hadler, Rachel, Laudanski, Krzysztof, Mackay, Emily J., Usman, Asad A., Gutsche, Jacob
• Format: Article
• Language: English
• Subjects: acute respiratory distress syndrome; acute respiratory failure; Anesthesia; Anxiety - epidemiology; Child, Preschool; extracorporeal life support; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Respiratory Distress Syndrome; Retrospective Studies; sedation
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2019.07.147

This retrospective study aimed to identify the association between long-term psychological impairment and total sedation received during venovenous extracorporeal life support (VV-ECLS) for acute respiratory failure (ARF). This observational retrospective study compared characteristics between patients with and without long-term psychological morbidity at long-term follow-up after VV-ECLS for ARF. A single institutional experience in a quaternary referral academic medical center in the United States. Patients who received VV-ECLS for ARF between January 1, 2015, and April 1, 2017, were identified for selection. Presence of psychiatric morbidity (anxiety and/or depression) was determined with the Hospital Anxiety and Depression Subscale battery at long-term follow-up. No interventions were made during this retrospective observational study. A total of 42 patients (21 male, 21 female, median age 49 [interquartile range {IQR} 36-57]) completed a telephone interview a median of 14.6 (IQR 7.7-21.1) months after ECLS decannulation. Cohorts were defined as possessing any psychiatric morbidity (anxiety and/or depression) as defined by the Hospital Anxiety and Depression Subscale battery (n = 22 [52%]) versus no psychiatric morbidity (n = 20 [48%]) at long-term follow-up. Patients who had clinically significant psychiatric morbidity received a median of 15.0 (IQR 11.0-17.0) days of continuous intravenous sedation compared with patients who had no psychiatric morbidity, who received a median of 10.0 (IQR 6.5-13.5) days of intravenous sedation; (p = 0.02). This retrospective analysis identified a significant association between the presence of long-term post-VV-ECLS psychiatric symptoms and the total number of days of intravenous sedation.