Long-Term Functional and Quality-of-Life Outcomes in Survivors of Refractory Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

IMPORTANCE: Long-term functional outcomes and health-related quality of life (HRQoL) in survivors of cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation (ECMO) remain poorly understood. OBJECTIVES: This study aimed to evaluate these outcomes in a cohort of venoarterial ECMO survivors. DESIGN, SETTING, AND PARTICIPANTS: This single-center observational study was conducted in the ICU of a French academic hospital and included consecutive adult patients treated with venoarterial ECMO who were discharged alive between February 2016 and December 2021. MAIN OUTCOMES AND MEASURES: The primary endpoint was a favorable functional outcome at least one year after ICU discharge, defined as a score on the modified Rankin Scale of 0 or 1, indicating no functional limitations affecting usual activities. Secondary endpoints included HRQoL, assessed using the EuroQol 5D five levels (EQ-5D-5L) and 36-item short-form health survey (SF-36) questionnaires. Of 79 hospital survivors, 65 patients were evaluated after a median follow-up of 2.8 years (1.2–4.2 yr). A favorable functional outcome was observed in 35 of 65 patients (54%). No association was found between ICU admission characteristics, serum neurobiomarkers (neuron-specific enolase, S100B), electroencephalogram findings during venoarterial ECMO, and functional outcome. Male sex was the only parameter associated with higher odds of favorable functional outcome (adjusted odds ratio, 4.19; 95% CI, 1.35–14.5). HRQoL assessments showed moderate-to-severe issues in 15% of patients, mainly affecting mobility, pain/discomfort, and mental health. Patients with favorable outcomes reported better scores across all domains of the EQ-5D-5L and higher scores on both the physical and mental components of the SF-36. CONCLUSIONS AND RELEVANCE: Approximately half of venoarterial ECMO survivors achieved excellent long-term functional outcomes. Nonetheless, a subset experienced ongoing limitations, particularly related to physical function and mental health, underscoring the need for targeted long-term follow-up and support.