Life after ECMO: A Comprehensive Review of Longterm Complications

Extracorporeal life support is the ability to temporarily supplement pulmonary and/or cardiac function in the setting of severe organ failure, with the most widely used version of this technology being extracorporeal membrane oxygenation (ECMO). While ECMO acutely improves outcomes in many patients with acute cardiopulmonary failure, evidence shows that survivors are at risk for long-term complications. These may include physical limitations, neurocognitive impairment, and psychological distress, all of which cumulate to impact a patient’s quality of life. The purpose of this research paper is to examine the literature on long-term complications associated with ECMO therapy and their impact on patient quality of life. Sources were selected using a PubMed search on ECMO long-term complications in adults, which yielded 222 studies. Twenty relevant peer-reviewed sources were chosen based on the specific selection criteria which included: long-term complications defined as those occurring at least 6 months after ECMO therapy, adult defined as 18 years or older, and studies produced within the past 5-6 years. Additional sources were found with the assistance of Google Gemini and reviewed for relevance using the same search criteria. Complications of the yielded studies are organized into three primary categories: organ-specific complications, psycho-social complications, and functional complications. The results of this study demonstrate a wide variety of longterm complications for providers to consider prior to the initiation of ECMO. The most significant complications included acute brain injury (ABI), heart failure, post-traumatic stress disorder (PTSD), and decrease in functional status. These findings suggest clinicians caring for ECMO patients should devote appropriate attention to the long-term follow-up needs of survivors. Topics of future research may include definitive guidelines for initiation, validated risk-stratification tools, and optimal weaning protocols for decannulation.