50: The Long Term Psychosocial Impact of Awake ECMO: A Case Report

Background: Rehabilitation on veno-venous extracorporeal membrane oxygenation (VV-ECMO) can reduce ICU-acquired weakness. However, the psychological impact of being awake on ECMO is seldom explored. This case highlights the long-term impact of Post Intensive Care Syndrome (PICS) in ECMO survivors. Case Description: Patient X is a married father and medical professional, previously high functioning and active. His medical history included mild hypertrophic cardiomyopathy (HCM). He was admitted to Barts Heart Centre with septic cardiomyopathy and cardiogenic shock, requiring veno-veno-arterial (V-VA) ECMO. He was extubated on day 7, weaned off sedation and cardiac support, but continued VV-ECMO to facilitate rehabilitation. Post-extubation, he was CAM-ICU positive but able to participate in active rehabilitation, including sitting and upper and lower limb exercises. ECMO was decannulated on day 8. He regained physical function and performed well on standardized cognitive assessment, and was discharged on day 14. At the 3-month Critical Care Follow-Up Clinic (CCFU), he exhibited psychosocial impairments impacting occupational engagement, work, and parenting. Psychological trauma was driven by his time awake on ECMO (IPAT 15/20), with severe anxiety, flashbacks, auditory hallucinations, guilt, and hypervigilance. Over 10 months, the CCFU team provided psychology referral, virtual rehabilitation (ICUsteps Active), ICU timeline review, respiratory referral, ICU visit, vocational rehabilitation, cognitive rehabilitation, basic counseling, and patient and family day. One-year post-discharge, he remains under CCFU clinic, respiratory investigation, and EMDR therapy. The impact of PICS continues to affect daily life, including divorce, inability to run, and inability to return to his previous work role. Conclusion: VV-ECMO rehabilitation supports physical recovery but can have long-lasting psychosocial impacts. Survivors require personalized, ongoing care during community reintegration. This case emphasizes the need for early psychological support and the development of a UK-wide ECMO support network.