Life After the Lifeline

What Happens to Adults After ECMO?

Imagine being so sick that your heart or lungs (or both!) just can't work anymore. That's where ECMO (Extracorporeal Membrane Oxygenation) comes in. It's like a temporary artificial heart and lung machine that takes over these vital functions, giving your own organs a chance to rest and heal. In recent years, more and more adults have been using ECMO, and thankfully, many are surviving. But what happens to them after they leave the hospital? This is a huge question for doctors and specialists, and recent studies are giving us a clearer picture of their long-term recovery and quality of life.

When we talk about "quality of life," we mean how someone's health affects their daily living, including their physical abilities, mental well-being, and social life. For ECMO survivors, this journey is often complex and challenging.

Beyond the Hospital Doors: Survival and Getting Back to Life

The good news is that many adults who receive ECMO treatment survive to go home, and a large number continue to live for years afterward.

• One study looked at 241 ECMO patients and found that almost two-thirds (62.7%) survived to leave the hospital. Of those survivors, 85% were still alive almost three years later.

• For patients who used VV-ECMO (Veno-Venous ECMO), which primarily helps the lungs, about 45% survived their hospital stay. Among these hospital survivors, a very high number were still alive at 6 and 12 months (89% and 85%, respectively). Some studies even show a 68.5% survival rate for VV-ECMO survivors nearly 10 years after leaving the ICU.

• However, for patients on VA-ECMO (Veno-Arterial ECMO), which supports both the heart and lungs, the picture can be tougher. A study found that 70.6% of these patients either died or had new disabilities 12 months after starting ECMO. But there's a silver lining: between 6 and 12 months after VA-ECMO, more patients became independent in daily activities (like self-care) and fewer were unemployed due to health issues. This suggests that the biggest challenges with disability often happen in the first six months, and then things tend to stabilize.

A big part of getting back to life is being able to take care of yourself and, for many, returning to work.

• One study found that 80% of VV-ECMO survivors were able to return to work, with most going back to their old jobs.

• But in another study, only about 37.7% of all ECMO survivors (including VA-ECMO patients) were employed, and more than half (56.6%) had trouble with social activities. These differences might be because of the type of ECMO used or whether retirees were included in the "employed" group. In general, most ECMO survivors (72.65% in one study) eventually become independent in their self-care.

The Realities of Recovery: Quality of Life

While survival rates are encouraging, the daily lives of ECMO survivors can be significantly changed.

• Overall, ECMO survivors tend to have a lower quality of life across many areas compared to healthy people. This includes things like physical activity, managing daily tasks, bodily pain, overall health, energy levels, and even emotional well-being. Physical issues, like reduced movement and pain in the legs or feet, are common, sometimes because of the tubes placed in their veins during ECMO.

• However, some studies suggest that the reduced quality of life for VV-ECMO survivors might be similar to, or even better than, that of ARDS patients who didn't receive ECMO. This could be because ECMO allows for gentler breathing machine settings, which might prevent lung damage and other problems associated with traditional mechanical ventilation.

• Mental health is a big concern. Many ECMO survivors are at high risk for Post-Traumatic Stress Disorder (PTSD), with one study reporting that about 30.8% of survivors were in the highest risk group. Other studies found different rates, with one Chinese study reporting 17% experiencing high stress levels. Anxiety and depression are also common. However, some studies show that mental health levels in survivors can be similar to, or even better than, the general population. This might be because psychological states can improve over time after discharge.

What Affects the Journey? Key Influencing Factors

Several things can affect how well an ECMO patient recovers and their quality of life afterward:

• Why they needed ECMO: The original reason a patient needed ECMO can significantly impact their long-term survival. For example, patients with primary graft dysfunction (problems with a transplanted organ) or respiratory failure tended to have better long-term survival.

• How long they were on ECMO: The longer someone is on ECMO, especially VV-ECMO, was found to be the most important factor for survival in the months after hospital discharge.

• Other health problems: Conditions a patient had before ECMO, like lung fibrosis, liver disease, or a weakened immune system, were linked to higher death rates in the hospital. However, for those who survived to go home, these pre-existing conditions seemed to play a smaller role in their long-term survival. This suggests that patients with less severe pre-existing conditions are more likely to survive the initial critical period.

• Support at home and social factors:

  • Who takes care of them (e.g., a spouse) can affect their quality of life, possibly because of the emotional burden on spouses.

  • Being employed after discharge is strongly linked to a higher quality of life, both physically and mentally.

  • Where they live (city vs. rural area) can also influence quality of life, possibly due to access to healthcare and resources.

• How they're doing physically and mentally: Better ability to care for themselves (measured by tests like the Barthel Index), lower levels of PTSD, and better social functioning were all linked to an improved quality of life.

Looking Ahead: How We Can Improve Care

The findings clearly show that caring for ECMO survivors doesn't end when they leave the hospital. Here are some important steps suggested by the research:

• Ongoing Support and Rehabilitation: It's really important to have long-term follow-up and special rehabilitation programs for ECMO survivors. These programs should offer physical, mental, and social support specifically designed for their needs.

• Dedicated ECMO Clinics: Setting up specialized ECMO clinics where patients can get comprehensive care, including online check-ups and even home visits, is seen as vital for their long-term well-being.

• Focus on Early Recovery: Since a lot of disability can develop in the first six months after VA-ECMO, it's important to collect more information during this early period after discharge to understand changes and trends in their health.

• More Research: To truly understand how ECMO affects long-term health and to confirm these findings, we need larger studies involving many hospitals that follow patients over time. Also, since quality of life is very personal, studies that listen to patients' own stories are needed to understand their experiences and needs more deeply. Research is also needed in different parts of the world to see how healthcare quality and social factors play a role.

In conclusion, ECMO is a powerful tool that saves lives. But the journey of recovery for these patients is long and involves many different aspects of their health. By focusing on continued care, support, and rehabilitation, healthcare providers around the world can help ECMO survivors not just survive, but truly live well after their critical illness.

AI and My ECMO Learning Journey

AI plays a significant role in how I research, understand, and communicate complex ECMO topics. From analyzing source materials to organizing ideas and generating podcast outlines, AI helps me stay curious and keep learning, so I can continue sharing insights with you.

Explore More:

• lifesupport.training – Resources for ECMO and other professionals

• ecmo.life – Information for ECMO patients and their loved ones

• Occasional podcasts: youtube.com/@ecmo-143

• LinkedIn Newsletter: ECMO 143: AI-Assisted Journey

Custom GPTs I Created:

• AI ECMO Expert – A custom GPT designed to assist with ECMO research and education.

• Micro Definitions (MD-GPT) – A custom GPT providing concise definitions for medical terminology.

Disclaimer:

This article is for educational purposes only and reflects the author’s understanding and interpretation of available guidelines, literature, and bedside learning. It does not constitute medical advice or represent institutional protocols. Always consult your ECMO team and local policies when making clinical decisions.

References:

1. Harley O, Reynolds C, Nair P, Buscher H. Long-term survival, posttraumatic stress, and quality of life post extracorporeal membrane oxygenation. ASAIO J. 2020;66(8):909-914. doi:10.1097/MAT.0000000000001095

2. Serpa Neto A, Higgins AM, Bailey MJ, et al. Long-term functional outcomes in the first 12 months after VA-ECMO in adult patients: a prospective, multicenter study. Circ Heart Fail. 2025;18(4):e012476. doi:10.1161/CIRCHEARTFAILURE.124.012476

3. Zeng X, Yang F, Luo X, et al. Long-term health related quality of life in adult extracorporeal membrane oxygenation survivors: a single-centre, cross-sectional study. BMC Public Health. 2024;24(1):3243. doi:10.1186/s12889-024-20782-5

4. Rilinger J, Krötzsch K, Bemtgen X, et al. Long-term survival and health-related quality of life in patients with severe acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation support. Crit Care. 2021;25(1):410. doi:10.1186/s13054-021-03821-0

5. Kurniawati ER, Rutjens VGH, Vranken NPA, et al. Quality of life following adult veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review. Qual Life Res. 2021;30(8):2123-2135. doi:10.1007/s11136-021-02834-0