Age-Related Quality-of-Life Analysis in Postcardiotomy Patients in Need of Extracorporeal Membrane Oxygenation

Background: The aims of the study were (1) to measure short-term outcomes, including survival-to-discharge rates and causes of in-hospital deaths, (2) to measure long-term survival in patients suffering from PCS requiring VA ECMO, (3) to measure quality of life (QoL) using the European Quality of Life 5 Dimensions 5 Level Version (EQoL-5D-5L), and (4) and to explore possible differences between patient groups according to a cut-off age of 70 years.

Method: Between August 2006 and December 2018, a total of 200 consecutive patients were identified. The population was divided into two groups according to a cut-off age of 70 years. Comparative outcome analysis was applied utilizing the EQ-5D-5L and the visual analog scale (VAS).

Results: The groups consisted of 113 patients ≤70 years (y) and 87 patients >70 years (o), and 52% of the population received ECMO assisted resuscitation. The overall survival-to-discharge rate was 31.5%, noticing a significantly better survival to discharge in the young group (y = 38.9%; o = 21.8%; p = 0.01). A total of 42 patients participated in the survey comprising 25 patients <70 years at the time of surgery after a median time period of 4.3 years after the index procedure. Statistically more patients in the older group stated to have any problems in mobility (y = 52% vs. o = 88%, p = 0.02) and self-care (y = 24% vs. o = 76%, p = 0.01). However, if the arbitrary cut of age of 70 years is set at the time point of QoL evaluation, the difference in the dimension mobility disappeared. Regression analysis revealed that sex, the comorbidities, or emergency cases had no impact on the EQ-5D-5L index. The VAS analysis revealed that there are no differences in the patient's self-perception of general health between both groups. The comparison of the indices with an age adjusted German reference population revealed no statistical difference.

Conclusion: We conclude that age per se represents no reason with regard to quality of life to withhold ECMO in postcardiotomy patients. Although older patients in need of VA ECMO show lower survival, the self-reported general health status seems to be good, with some features in daily living being certainly impaired.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023