Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study

Abstract

IntroductionCritical illness is a well-recognized cause of neuromuscular weakness and impaired physical functioning. Physical therapy (PT) has been demonstrated to be safe and effective for critically ill patients. The impact of such an intervention on patients receiving extracorporeal membrane oxygenation (ECMO) has not been well characterized. We describe the feasibility and impact of active PT on ECMO patients.MethodsWe performed a retrospective cohort study of 100 consecutive patients receiving ECMO in the medical intensive care unit of a university hospital.ResultsOf the 100 patients receiving ECMO, 35 (35%) participated in active PT; 19 as bridge to transplant and 16 as bridge to recovery. Duration of ECMO was 14.3 ± 10.9 days. Patients received 7.2 ± 6.5 PT sessions while on ECMO. During PT sessions, 18 patients (51%) ambulated (median distance 175 feet, range 4 to 2,800) and 9 patients were on vasopressors. Whilst receiving ECMO, 23 patients were liberated from invasive mechanical ventilation. Of the 16 bridge to recovery patients, 14 (88%) survived to discharge; 10 bridge to transplant patients (53%) survived to transplantation, with 9 (90%) surviving to discharge. Of the 23 survivors, 13 (57%) went directly home, 8 (35%) went to acute rehabilitation, and 2 (9%) went to subacute rehabilitation. There were no PT-related complications.ConclusionsActive PT, including ambulation, can be achieved safely and reliably in ECMO patients when an experienced, multidisciplinary team is utilized. More research is needed to define the barriers to PT and the impact on survival and long-term functional, neurocognitive outcomes in this population.

Extracorporeal life support for adult cardiopulmonary failure

“…In some circumstances, VV ECMO via a dual lumen cannula can provide sufficient gas exchange to allow for the removal of mechanical ventilatory support for patients awaiting lung transplantation. By avoiding femoral cannulation, such patients can also actively participate in physical therapy while on ECMO [32]. Cannulation StrategiesUntil recently, VV ECMO was commonly performed through a femoral venous drainage cannula and a jugular return cannula.…”

Extracorporeal Circulatory Approaches to Treat Acute Respiratory Distress Syndrome

“…79 However, these data are mostly limited to the population receiving extracorporeal support as a bridge to lung transplantation. [80][81][82][83] Although most patients with severe ARDS requiring ECMO are currently believed to be too critically ill to participate in active rehabilitation, a subset of patients may be appropriate for such interventions.…”

Extracorporeal techniques in acute respiratory distress syndrome

“…The mobilization of patients with respiratory failure requiring ECMO has been increasing overall, but this data is largely limited to patients who are awaiting lung transplantation (71)(72)(73)(74). While patients requiring ECMO for ARDS may often be too critically ill to participate in active rehabilitation, it may be possible in appropriate patients who are at centers that have a multidisciplinary approach to physical therapy (75)(76)(77). The benefit of mobilizing ARDS patients on ECMO has not been well defined and must be weighed against the potential risks of physical therapy in this population.…”