An Interprofessional Approach to Mobilizing Patients With COVID-19 Receiving Extracorporeal Membrane Oxygenation

Abstract

Objective To assess survival outcomes with the intervention of an interprofessional mobilization program for patients with COVID-19 who were receiving venovenous extracorporeal membrane oxygenation (VV-ECMO). Design Preintervention and postintervention retrospective cohort study. Methods Survival outcomes of nonmobilized, adult patients (n = 16) with COVID-19 who were receiving VV-ECMO (May 2020 through December 2020) were compared with those of 26 patients who received a mobility care plan (January 2021 through November 2021). In the preintervention group, full sedation and paralysis were used. In the postintervention group, an early mobilization strategy involving interprofessional collaboration was introduced. Results The postintervention group had improved survival (73.1% vs 43.8%; P < .04); fewer days of receiving paralytics, fentanyl, and midazolam (P < .01 for all); but more days of dexmedetomidine, morphine, and ketamine administration (P < .01 for all). Concomitantly, more patients in the postintervention cohort received oral or transdermal analgesics, oral anxiolytics, and oral antipsychotics (P < .01 for all), and also required more VV-ECMO cannula adjustments (P = .03). Conclusion Early mobilization of patients with COVID-19 who were receiving VV-ECMO improved survival rates but led to more cannula adjustments.

Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation

“…After duplicates removal and screening selection, 13 articles were included in the final analysis (Figure 1). Eight studies were observational retrospective designs, [31][32][33][34][35][36][37][38] four were case reports, [39][40][41][42] and one was a randomized controlled trial. 43 Four studies out of 13 included patients with COVID-19.…”

“…Additionally, early tracheostomy is increasingly performed within the first 48 h after cannulation to promote and expedite weaning and allow participation in rehabilitative activities. 33,35 Further research is also needed to define whether weaning from ECMO before weaning from ventilation is superior to weaning from ventilation before liberation from ECMO. 46 Several factors contribute to maintaining patients conscious and not intubated, such as the severity and etiology of the respiratory failure, the patient's initial 39 V-V (100) 8 1 (100) Mark et al 2020 40 V-V (100) 9 1 (100) Rinewalt et al 2019 41 V-A (100) 20 1 (100) Zhu et al 2019 42 V-V (100) 47 1 (100) Hayes et al 2021 43 IP V-V (14.3), V-A (85.7) SP V-V (50), V-A (50) IP 8.1 ± 4.9 SP 10.9 ± 5.5 --aLTx: after lung transplant; bLTx: before lung transplant; ECMO: extracorporeal membrane oxygenation; IP: intensive physiotherapy; IQR: interquartile range; PAFW: physiotherapy after the first week; PWFW: physiotherapy within the first week; SP: standard physiotherapy; V-A: venoarterial; V-AV: venoarterialvenous; V-V: venovenous.…”

“…Additionally, early tracheostomy is increasingly performed within the first 48 h after cannulation to promote and expedite weaning and allow participation in rehabilitative activities. 33,35 Further research is also needed to define whether weaning from ECMO before weaning from ventilation is superior to weaning from ventilation before liberation from ECMO. 46…”

“…34 Indeed, in the present review, rehabilitation is discussed as a unique intervention, although different professional figures, such as respiratory, physical and occupational therapists, are part of it. In three of the included studies, 34,35,42 it has been specified the role of occupational therapists in implementing the progression of rehabilitation sessions; occupational therapy is another area that could be explored better in ECMO contexts, as emerges from recent literature. 59…”

Patient Safety in the Critical Care Setting: Common Risks and Review of Evidence-Based Mitigation Strategies

“…Teaming on the fly is progressively common in critical care, especially when patients are experiencing hemodynamic instability and require emergent mechanical support. Extracorporeal membrane oxygenation can be used as a lifesaving strategy [145]. By default, this intervention requires a remarkably elevated level of interprofessional collaboration between perfusionists, respiratory therapists, physicians, physical therapists, and nurses, among many other roles.…”