Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring Extracorporeal Membrane Oxygenation

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) is a lifesaving modality that was in great demand for persons with severe COVID-19 infection. Although mobility of these patients has previously been safely reported anecdotally, there were no established guidelines to implement in a greatly expanded patient population, as occurred in the pandemic period. We describe the development and implementation of a program (Cannulate, Extubate, Ambulate) for team-based safe mobilization. Methods: The 3-phase protocol advances based on patient alertness/ability to actively participate. A physical therapist determined initial stage and progression and recommended mobility activities for carryover by nurses and/or ECMO specialists between skilled sessions. Results: The mobility program has been successfully implemented for 104 patients with severe COVID-19 without significant adverse events. Most patients (51%) ambulated while cannulated, and 60% were able to discharge directly home after hospitalization. Conclusions: This safe, effective program allowed extension of physical therapy goals in a highly complex patient population during a time of very high demand. Making early mobility a team goal enhanced buy-in, instead of relying exclusively on rehabilitation providers for mobilization. Utilization of the Cannulate, Extubate, Ambulate program may assist other programs to minimize complications of immobility in the ECMO population.

Relevant Work

“…Their lecture was one of the highlights in CSM 2022 and I am very happy that we are able to bring it in written form to our readers. Then, and still under the lessons learned because of the COVID-19 pandemic, DiVitto et al 3 propose a 3-phase protocol for patients under extracorporeal membrane oxygenation (ECMO), which has enhanced mobility and decreased hospitalization stay. Continuing with the APTA Academy of Cardiovascular and Pulmonary Physical Therapy's "Vitals are Vital" campaign, Smith et al 4 bring us a case report on the impact of in-service education to improve blood pressure measurement in outpatient rehabilitation.…”