Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Abstract

Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE ® , PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

Feasibility, safety, and resource utilisation of active mobilisation of patients on extracorporeal life support: a prospective observational study

“…To our knowledge, this is the largest prospective observational study investigating the feasibility, safety, and resource utilisation of active mobilisation of ECLS patients. Several retrospective observational studies and one small pilot randomised controlled study on active mobilisation on ECLS have been published elsewhere [13,14]. Abrams et al retrospectively studied the feasibility and safety of active mobilisation of 35 patients on veno-venous and veno-arterial ECMO and found no relevant complications associated with mobilisation [16].…”

“…Moreover, concerns about specific complications associated with active mobilisation of patients on ECLS, such as circuit malfunction and/or cannula complications, are potential barriers to active mobilisation of these patients [11,12]. So far, only a few retrospective cohort studies and one recent small pilot randomised controlled study have been published on the feasibility and safety of actively mobilising critically ill patients on ECLS [13,14].…”

A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams

“…The LRU, along with only a few select institutions, routinely ambulated ECMO patients [ 27 , 28 ]. Early mobilization and increased physical therapy lead to reduced cognitive and muscular deconditioning [ 29 , 30 ]. However, it requires a team of physical therapists, nurses, and patient care technicians for each patient, which requires dedicated resource allocation similar to provider and nursing teams.…”

Early mobilization post-myocardial infarction: A scoping review

“…These hemodynamic results serve to further support EM’s safety in acute cardiac care. Mobilization with devices that may be relevant to post-MI care in complex patients, such as those receiving percutaneous mechanical ventilation, mechanical circulatory support and continuous renal replacement therapy, have also been shown to be safe [ 12 , 56 , 57 ]. Even mobilization in people receiving vasoactive medications is not associated with hemodynamic instability [ 58 ].…”