{"id":22998,"date":"2022-11-08T04:37:00","date_gmt":"2022-11-07T20:37:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22998"},"modified":"2022-11-08T05:25:00","modified_gmt":"2022-11-07T21:25:00","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aecmo%e4%b8%8e%e5%ad%98%e6%b4%bb%e7%9a%84%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e6%96%b0%e5%8f%91%e7%b2%be%e7%a5%9e%e5%81%a5%e5%ba%b7%e8%af%8a","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22998","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aECMO\u4e0e\u5b58\u6d3b\u7684\u5371\u91cd\u75c5\u60a3\u8005\u65b0\u53d1\u7cbe\u795e\u5065\u5eb7\u8bca\u65ad\u7684\u76f8\u5173\u6027"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

October 26, 2022<\/p>\n\n\n\n

Association of Extracorporeal Membrane Oxygenation With New Mental Health Diagnoses in Adult Survivors of Critical Illness<\/h1>\n\n\n\n

Shannon M.\u00a0Fernando,\u00a0Mary\u00a0Scott,\u00a0Robert\u00a0Talarico,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online October 26, 2022. doi:10.1001\/jama.2022.17714<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Is the use of extracorporeal membrane oxygenation (ECMO) associated with postdischarge psychiatric morbidity among adult survivors of critical illness?<\/p>\n\n\n\n

Findings<\/strong>  In this population-based retrospective cohort study of 4462 participants, exposure to ECMO, compared with intensive care unit hospitalization without ECMO, was significantly associated with a modestly increased risk of new mental health diagnoses or social problems after discharge (hazard ratio, 1.24).<\/p>\n\n\n\n

Meaning<\/strong>  Among adult survivors of critical illness, receipt of ECMO was significantly associated with a modestly increased risk of new mental health diagnoses or social problems, but further research on the mechanisms underlying this relationship is needed.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients, but little is known regarding long-term psychiatric sequelae among survivors after ECMO.<\/p>\n\n\n\n

Objective<\/strong>  To investigate the association between ECMO survivorship and postdischarge mental health diagnoses among adult survivors of critical illness.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Population-based retrospective cohort study in Ontario, Canada, from April 1, 2010, through March 31, 2020. Adult patients (N=4462; age \u226518 years) admitted to the intensive care unit (ICU), and surviving to hospital discharge were included.<\/p>\n\n\n\n

Exposures<\/strong>  Receipt of ECMO.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was a new mental health diagnosis (a composite of mood disorders, anxiety disorders, posttraumatic stress disorder; schizophrenia, other psychotic disorders; other mental health disorders; and social problems) following discharge. There were 8 secondary outcomes including incidence of substance misuse, deliberate self-harm, death by suicide, and individual components of the composite primary outcome. Patients were compared with ICU survivors not receiving ECMO using overlap propensity score\u2013weighted cause-specific proportional hazard models.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Among 642 survivors who received ECMO (mean age, 50.7 years; 40.7% female), median length of follow-up was 730 days; among 3820 matched ICU survivors who did not receive ECMO (mean age, 51.0 years; 40.0% female), median length of follow-up was 1390 days. Incidence of new mental health conditions among survivors who received ECMO was 22.1 per 100-person years (95% confidence interval [CI] 19.5-25.1), and 14.5 per 100-person years (95% CI, 13.8-15.2) among non-ECMO ICU survivors (absolute rate difference of 7.6 per 100-person years [95% CI, 4.7-10.5]). Following propensity weighting, ECMO survivorship was significantly associated with an increased risk of new mental health diagnosis (hazard ratio [HR] 1.24 [95% CI, 1.01-1.52]). There were no significant differences between survivors who received ECMO vs ICU survivors who did not receive ECMO in substance misuse (1.6 [95% CI, 1.1 to 2.4] per 100 person-years vs 1.4 [95% CI, 1.2 to 1.6] per 100 person-years; absolute rate difference, 0.2 per 100 person-years [95% CI, \u22120.4 to 0.8]; HR, 0.86 [95% CI, 0.48 to 1.53]) or deliberate self-harm (0.4 [95% CI, 0.2 to 0.9] per 100 person-years vs 0.3 [95% CI, 0.2 to 0.3] per 100 person-years; absolute rate difference, 0.1 per 100 person-years [95% CI, \u22120.2 to 0.4]; HR, 0.68 [95% CI, 0.21 to 2.23]). There were fewer than 5 total cases of death by suicide in the entire cohort.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among adult survivors of critical illness, receipt of ECMO, compared with ICU hospitalization without ECMO, was significantly associated with a modestly increased risk of new mental health diagnosis or social problem diagnosis after discharge. Further research is necessary to elucidate the potential mechanisms underlying this relationship.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22998"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22998"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22998\/revisions"}],"predecessor-version":[{"id":22999,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22998\/revisions\/22999"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22998"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22998"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22998"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}