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

Abstract

Background There is scarce evidence on the feasibility, safety and resource utilisation of active mobilisation in critically ill patients on extracorporeal life support (ECLS). Methods This prospective observational single-centre study included all consecutive critically ill patients on ECLS admitted to an academic centre in Germany over a time period of one year. The level of mobilisation was categorised according to the ICU Mobility Scale (IMS). Primary outcome was complications during mobilisation. Results During the study period, active mobilisation with an activity level on the IMS of ≥ 3 was performed at least on one occasion in 43 out of 115 patients (37.4%). A total of 332 mobilisations with IMS ≥ 3 were performed during 1242 ECLS days (26.7%). ECLS configurations applied were va-ECMO (n = 63), vv-ECMO (n = 26), vv-ECCO2R (n = 12), av-ECCO2R (n = 10), and RVAD (n = 4). Femoral cannulation had been in place in 108 patients (93.9%). The median duration of all mobilisation activities with IMS ≥ 3 was 130 min (IQR 44–215). All mobilisations were undertaken by a multi-professional ECLS team with a median number of 3 team members involved (IQR 3–4). Bleeding from cannulation site requiring transfusion and/or surgery occurred in 6.9% of actively mobilised patients and in 15.3% of non-mobilised patients. During one mobilisation episode, accidental femoral cannula displacement occurred with immediate and effective recannulation. Sedation was the major reason for non-mobilisation. Conclusions Active mobilisation (IMS ≥ 3) of ECLS patients undertaken by an experienced multi-professional team was feasible, and complications were infrequent and managed successfully. Larger prospective multicentre studies are needed to further evaluate early goal directed sedation and mobilisation bundles in patients on ECLS.

Functional status of heart transplant recipients predicts survival

“…Braune et al reported the feasibility and safety of early mobilization of patients requiring extracorporeal life support when performed by a multidisciplinary team comprised of critical care nurses, physiotherapists, perfusionists, intensive care physicians, and cardiac surgeons. 15 Similarly, Perme et al has reported benefits in early physical therapy in LVAD patients. 16 For patients requiring intra-aortic balloon pump support, it is possible to place the catheter via the axillary artery, facilitating ambulation with reasonable outcomes.…”

“…Braune et al. reported the feasibility and safety of early mobilization of patients requiring extracorporeal life support when performed by a multidisciplinary team comprised of critical care nurses, physiotherapists, perfusionists, intensive care physicians, and cardiac surgeons 15 . Similarly, Perme et al.…”

Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support

“…Only 583 reported potential safety events, for a cumulative incidence of 2.6%, such as oxygen desaturation, hemodynamic changes, and removal or dysfunction of intravascular catheter [78]. Other safety events were falls and cardiac arrests in a quite small rate [74]. Feasibility and safety of ECMO rehabilitation in the ICU have been also shown during the last decade as shown in Table 1.…”

“…Strength training is an important rehabilitation tool of ICU-AW prevention and treatment in patients on ECMO support. Most exercise training protocols perform both aerobic exercise and strength endurance training [52][53][54][55][56][57][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. Strength training exercises could be either passive in-bed for the early stages of prehabilitation and early mobilization, or active out-of-bed for conscious patients with better neuromuscular conditions and functional capacity.…”

“…Passive or in-bed strength exercises include strengthening and reconditioning exercises in the supine position, such as ankle pumps, heel slides, upper extremity stretching, and a range of motion exercises [53], exercises in the sitting position on the edge of the bed to strengthen the torso, upper extremities, and lower extremities such as leg lifts, ankle rolls, and arm lifts [53], sitting in the bed or at the edge of bed, standing, functional electrical stimulation cycling in quadriceps, hamstrings, and buttocks bilaterally [65], and generally a various range of motion at the bedside [72,75,77]. On the other hand, active or out-of-bed strength exercises include muscle training of the lower extremities, such as dynamic quadriceps training by leg press, bed bike, or squats from sitting position and bed-to-chair mobilization [61], active exercises with elastic bands, mini-leg press [70], sit-to-stand transfer activities and functional strengthening using sit-to-stand from the bed or chair [72], stand-pivot transfers or taking small steps from the bed or chair with purpose to transfer to another surface [72], standing activities such as standing balance and tolerance, strengthening, weight shifting, marching, and stepping in place [72], active upper and lower limb and endurance exercises [74], or weight training of the upper limbs [77]. Intensity and the number of repetitions of strength exercises are usually individualized for each patient separately, according to his/her functional status and the stage of rehabilitation after evaluating maximum muscle strength of the muscle training group with one repetition maximum (1 RM) and/or handgrip and handheld dynamometers assessment.…”