key: cord-0763854-afify7hx authors: Mayer, Kirby P.; Jolley, Sarah E.; Etchill, Eric W.; Fakhri, Shoaib; Hoffman, Jordan; Sevin, Carla M.; Zwischenberger, Joseph B.; Rove, Jessica Y. title: Long-term Recovery of Survivors of COVID-19 Treated with ECMO: The Next Imperative date: 2020-11-25 journal: JTCVS open DOI: 10.1016/j.xjon.2020.11.006 sha: d4a3e63a54665431d04752c9bb9ded88986a783b doc_id: 763854 cord_uid: afify7hx nan The novel pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 83 triggering coronavirus disease 2019 (COVID-19) leads to invasive mechanical ventilation in an 84 estimated 20% of hospitalized patients with an associated mortality as high as 80%. 1 Group, a broadly multidisciplinary collaboration between five academic medical centers who 94 incorporate protocolized outpatient post-intensive care unit (ICU) follow up of survivors of 95 COVID-19 associated ARDS who were supported with ECMO ( Figure 2 ). The goal of this 96 collaborative is to characterize the recovery of these patients and target future investigations 97 aimed at optimizing their survivorship. 98 Post-intensive care syndrome is a term used to describe the collective impairments in 100 physical function, mental health, and cognition observed in ICU survivors. Follow up of ARDS 101 survivors including those who had Influenza A subtype H1N1 or Severe Acute Respiratory 102 Syndrome, shows these deficits can persist for years and negatively impact meaningful 103 recovery. 4-12 For example, at 1 year from hospitalization, one-third of previously employed ICU 104 those treated with ECMO, are at risk for long-lasting sequelae of their critical illness. 14,15 106 Specific physical impairments of ICU survivors include neuromuscular weakness, ICU-107 acquired weakness and musculoskeletal pain. 16 Though decreasing sedation requirements for ECMO patients may reduce their risk of physical 148 and cognitive deficits, accidental ECMO decannulation can be lethal and cause unintended viral subsequent re-intubation, creating an additional high-risk exposure. Only follow up of these 151 patients with COVID-19 associated ARDS treated with ECMO will determine the long-term 152 impact of these disrupted critical care practices. 153 Since the majority of survivors are at high risk for more than one impairment in 155 cognitive, physical or emotional health, protocolized follow up is our best mechanism to define 156 walk test, spirometry, dyspnea score, the EQ-5D general health questionnaire, Patient Health 396 Questionnaire-9 (PHQ-9) depression screen, Impact of Event Scale (IES) post-traumatic stress 397 disorder (PTSD) screen, Generalized Anxiety Disorder 7-item (GAD-7) screen, and the Montreal Health-related quality of life. Long-term survival in 315 patients with ARDS Long-Term Survival, Posttraumatic Stress, and 318 Quality of Life post Extracorporeal Membrane Oxygenation Long-term neurocognitive outcome is not worsened 321 by of the use of venovenous ECMO in severe ARDS patients Early mobilization of patients receiving 324 extracorporeal membrane oxygenation: a retrospective cohort study Active rehabilitation during extracorporeal 327 membrane oxygenation as a bridge to lung transplantation Feasibility and Safety of Early Physical Therapy and Active 330 Mobilization for Patients on Extracorporeal Membrane Oxygenation Early physical and occupational 333 therapy in mechanically ventilated Acute Care Hospital Setting: Historical Perspectives and Practical Implications Clinical practice guidelines for the management of pain, 340 agitation, and delirium in adult patients in the intensive care unit Clinical Practice Guidelines for the Prevention Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Caring for Critically Ill Patients with the 346 ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness* Implementation of an ICU Recovery Clinic 352 at a Tertiary Care Academic Center Comprehensive care of 355 ICU survivors: Development and implementation of an ICU recovery center CE: critical care recovery center: an innovative 358 collaborative care model for ICU survivors Inverse Dose-Response Relationship Between Home Health Care Services and Rehospitalization in Older Adults Rehospitalization in a National Population of Home Health Care Patients with Heart After Stroke and Risk of Hospital Readmission Core Outcome Measures for Clinical 373 Research in Acute Respiratory Failure Survivors