To the Editor:
Current trials published in medical literature, and especially the critical care literature, measure similar primary endpoints, namely, mortality. This measure is often an appropriate way of examining the effectiveness of some of our most novel and innovative treatments. Many trials also measure a number of other secondary endpoints, including time free from a ventilator or time spent in the hospital. But often these trials do not describe a patient’s neurologic status or functional status after these interventions. Treatments for medical conditions once thought nonsurvivable have advanced rapidly in recent years. Patients can be kept alive in the face of complete failure of multiple organs, often for extended periods of time. While mortality is an important endpoint, we applaud the recent publication by Grasselli et al.1 for examining endpoints specifically related to a patient’s quality of life.
An excellent example of quality of life–related outcomes research is in the cardiac arrest literature and the use of the modified Rankin scale to show neurologic outcomes after interventions.2 Given that the incidence of the post–intensive care syndrome, or one of its three components, can be 25% or higher for patients and families or caregivers,3 we think the time is right to expand outcomes to examine a patient’s functional status and quality of life after discharge from the intensive care unit. In a recent meta-analysis, only 48 studies out of 11,927 (0.4%) included health-related quality of life after discharge from the intensive care unit as an outcome measure.4
In a recent large trial of extracorporeal membrane oxygenation (extracorporeal membrane oxygenation for acute respiratory distress syndrome),5 60-day mortality was not different between extracorporeal membrane oxygenation and conventional mechanical ventilation, but there was no information gathered on patients’ quality of life after these interventions. Therefore, we were delighted to see Grasselli et al.’s1 publication related to quality of life after extracorporeal membrane oxygenation and applaud them for including these measures in those who survived a very severe illness. The finding that those who underwent treatment with extracorporeal membrane oxygenation had less of an impact on health-related quality of life is especially important for such an invasive intervention. Could extracorporeal membrane oxygenation be a mechanism for helping people recover closer to their baseline functional status? Also, the fact that this intervention is often offered to a younger patient population (in this study, an average age of 54 yr)1 makes us more hopeful that survivors of extracorporeal membrane oxygenation can have an acceptable quality of life for many years into the future.
We are hopeful that publications such as Grasselli et al.’s1 are the beginning of a trend to new measures in the medical literature. Since “the ultimate goal of health care is to restore or preserve functioning and well-being related to health,”6 measures such as these may shed new light on treatments that allow our patients to be happier and more satisfied with their medical care.
The authors declare no competing interests.