Identification and prevalence of PTSD risk factors in ECMO patients: A single centre study

Ralph Tramm; Carol Hodgson; Dragan Ilic; Jayne Sheldrake; Vincent Pellegrino

doi:10.1016/j.aucc.2014.04.005

Identification and prevalence of PTSD risk factors in ECMO patients: A single centre study

Aust Crit Care. 2015 Feb;28(1):31-6. doi: 10.1016/j.aucc.2014.04.005. Epub 2014 May 17.

Authors

Ralph Tramm¹, Carol Hodgson², Dragan Ilic³, Jayne Sheldrake⁴, Vincent Pellegrino⁴

Affiliations

¹ Monash University, Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Australia. Electronic address: Ralph.Tramm@Moansh.edu.au.
² Monash University, Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Australia; The Alfred Hospital, Department of Physiotherapy, Australia.
³ Monash University, Department of Epidemiology and Preventive Medicine (DEPM), Australia.
⁴ The Alfred Hospital ICU, Australia.

PMID: 24844865
DOI: 10.1016/j.aucc.2014.04.005

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is one of the most invasive rescue therapies for acute heart and/or lung failure. Survivors have high rates of adverse mental health outcomes, such as post-traumatic stress symptoms (PTSS) and manifest post-traumatic stress disorder (PTSD). Yet no study to date has identified and explored PTSD risk factors in these patients.

Objectives: The primary aim of this study was to determine and explore post-traumatic stress risk factors for patients treated with ECMO. It also aimed to provide a baseline profile for future hypothesis testing with respect to risk factor exposure, level of exposure and post-traumatic stress outcomes in these patients.

Methods design: Retrospective cohort study.

Setting: The study was conducted at the Alfred Hospital Melbourne, Australia.

Participants: Patients were selected in 2012 from an Intensive Care Unit (ICU) registry that prospectively included all patients admitted to ICU and treated with ECMO.

Data extraction and analysis: Data were extracted from the ICU ECMO registry, ICU and ward charts, progress notes, referrals, drug charts and discharge letters. Data were descriptively analysed.

Results: Patients treated with ECMO are exposed to almost all investigated PTSD risk factors. These included psychiatric history (psychiatric comorbidities), admission to ICU and treatment (prolonged ventilation during prolonged ICU stay), and drug therapy (all patients treated with PTSD risk related drugs).

Conclusion: ECMO patients are exposed to PTSD risk factors such as young age, mechanical ventilation, drug administration, delirium and agitation. Younger age, heterogeneous conditions, profound illness severity and prolonged ICU stay describe the case complexity of patients and may explain these findings. Patients in ICU are increasingly conscious during active treatment and this may have positive or negative psychological effects. "Awake" ECMO in which patients are conscious while on active life support may represent a unique PTSD risk factor in this perspective.

Keywords: Cohort studies; Extracorporeal membrane oxygenation; Intensive Care Units; Intensive care/methods; Mental health; Retrospective studies; Risk assessment; Stress disorders, post-traumatic.

MeSH terms

Extracorporeal Membrane Oxygenation*
Female
Humans
Intensive Care Units
Male
Middle Aged
Prevalence
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stress Disorders, Post-Traumatic / epidemiology*
Victoria / epidemiology