Awake ECMO and mobilizing patients on ECMO

Abstract

Extracorporeal membrane oxygenation (ECMO) is a lifesaving technology in critically ill patients who present with cardiac/ pulmonary/combined cardiopulmonary failure. These patients are the sickest of all patients in any critical care unit and will invariably have a prolonged course and rehabilitation. Spontaneous breathing and early mobilization can reduce the intensive care unit (ICU)-acquired weakness, improve functional recovery, and reduce superadded infections and length of stay in the hospital, thus decreasing the cost of treatment. In low socioeconomic countries, there is an associated challenge of the availability of specially trained personnel necessary to manage patients on ECMO. Managing and ambulating an awake patient on ECMO is very labour-intensive and poses various challenges. Every ECMO program should aim to develop goals, methods, and protocols to this end. These can be derived from best practices worldwide by suitably adapting to available personnel and equipment. In this review, we aim to highlight the advantages and associated challenges of awake ECMO and describe protocols to aid safe ambulation and physiotherapy for ECMO patients.

Specialist Palliative Care Consultations in COVID-19 Patients in the ICU—A Retrospective Analysis of Patient Characteristics and Symptoms at a German University Hospital

“…The special role of sPC in COVID-19 treatment is also due to the increasing treatment of fully awake patients with EMCO, which is demanding and represents new challenges [ 49 ]. This is challenging for the ICU staff, as they usually treat patients under sedation, and the sPC teams can particularly support here.…”

Silicosis-associated Severe Pneumonia Treated by Veno-veno-venous Extracorporeal Membrane Oxygenation: a Case Report

“…If the patient's respiratory function is good, such as SpO 2 > 96%, PaO 2 > 80%, PaCO 2 < 45%, clear consciousness, partner treatment, endotracheal intubation can be removed, and ECMO (awake ECMO) treatment can be carried out in the state of consciousness. Theoretically, this state is conducive to reducing the risk of infection and pulmonary complications of mechanical ventilation, conducive to nursing, reducing the occurrence of pressure ulcers, and to the normal balance of intestinal nutrition and intestinal ora [2][3][4] . The patient in this case, had poor oxygenation under V-V ECMO and endotracheal intubation-assisted ventilation.…”

Extracorporeal Membrane Oxygenation: Beyond Conventional Indications

“…Patients might need to be sedated immediately after ECMO initiation, to ensure hemodynamic stability and proper gas exchange. Afterwards, gradual weaning of sedation is advised [32].…”