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Long-term neuropsychiatric symptoms as well as neurologic and functional impairment are common in patients who receive extracorporeal membrane oxygenation (ECMO) support, results of a new meta-analysis showed.

More than half of patients reported pain or discomfort, nearly one third experienced depression, and 52% had functional impairment that affected their daily lives. Only 28% had a favorable neurologic outcome a year after ECMO.

"Our meta-analysis reveals a concerning prevalence of neuropsychiatric, neurocognitive, and functional impairments in ECMO patients," senior author Sung-Min Cho, DO, MHS, director of Adult ECMO Research at Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues wrote.

The findings were published online on January 5, 2024, in Neurology.

The meta-analysis included 59 studies with 3280 patients (69% male; median age, 54 years). The majority (86%) received venoarterial ECMO, most often for extracorporeal cardiopulmonary resuscitation and cardiogenic shock.

Venovenous ECMO was used most often for acute respiratory failure.

After a median follow-up of 16 months, the overall prevalence of neuropsychiatric symptoms was 41% (95% CI, 33%-49%). More than half had pain/discomfort, 37% had sleep disturbance, 46% had anxiety, 31% had depression, and 18% had posttraumatic stress disorder.

The prevalence of neurocognitive impairment was 38%, and 52% had functional impairment that affected daily activities, mobility, and self-care.

Patients who received venovenous ECMO had a significantly higher prevalence of neuropsychiatric symptoms than those who received venoarterial ECMO (55% vs 32%; P = .01). There was no difference between groups in prevalence of neurocognitive and functional impairment.

Among all patients who received ECMO, including nonsurvivors, a favorable neurologic outcome was reported in just 23% of patients at 3 months, 25% at 6 months, and 28% at ≥ 1 year.

Neurologic outcomes were better when examining only ECMO survivors, with 90% reporting favorable outcomes at ≥ 1 year, which suggests, "ECMO patients who are successfully discharged can achieve good neurologic recovery over time," the investigators wrote.

The findings are concerning, but "it should be duly noted that ECMO itself may not actually increase the prevalence of neuropsychiatric symptoms and neurocognitive impairment; rather, the severity of critical illness that is treated with ECMO may be the underlying reason," they added.

Authors of an accompanying editorial noted that the study "raises awareness among neurologists, psychiatrists, and physiatrists, all of whom have an increasing role to play in the convalescence of ECMO survivors."

Imad R. Khan, MD, Department of Neurology, University of Rochester Medical Center, Rochester, New York, and Nicholas A. Morris, MD, Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland, noted that while ECMO can be lifesaving for the sickest patients, information on outcomes among survivors has been lacking.

Understanding long-term functional and neuropsychiatric outcomes following ECMO is important to avoid post-intensive care syndrome and direct neurologic injury, they wrote.

"The past four decades of ECMO utilization have resulted in lives saved at a steep cost," they continued. "As survival increases with improvements in care delivery, refinements in patient selection, and technological advances, the mission shifts from helping patients survive to helping survivors thrive."

The study was funded by the National Heart, Lung, and Blood Institute. Kalra and Morris reported no disclosures. Khan is funded as a site PI for the National Institutes of Health. Full disclosures are included in the original articles.

Kelli Whitlock Burton is a reporter for Medscape Medical News covering neurology and psychiatry.