Safety of Nurse Driven Ambulation for Patients on Venovenous Extracorporeal Membrane Oxygenation

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

“…The underlying diseases or clinical conditions that led to the indication of ECMO were cystic fibrosis, (11,19,20,23,31-33,36) pulmonary fibrosis, (11,19,20,23,31-33,36) acute respiratory failure, (21,24,25,36) acute respiratory distress syndrome (ARDS), (11,29,33,35) chronic obstructive pulmonary disease, (11) idiopathic pulmonary disease, (11) pulmonary arterial hypertension, (11) usual interstitial pneumonia, (19) acute viral interstitial pneumonia, (28) pneumonia, (19) bridge to lung transplantation (LT), (22,26,34) asthma, (27) lymphangioleiomyomatosis, (23) pleuroparenchymal fibroelastosis, (32) pulmonary embolism, (37) cardiogenic shock, (37) and ventricular dysfunction after cardiac procedure. (37) One study (30) did not report the reason for using ECMO in the sample (n = 10).…”

“…Nineteen studies (11,19-23,25-37) performed physical rehabilitation using different techniques and physical exercises, including active-assisted exercises (17 studies), (11,19,20,22,23,26-37) sitting (12 studies), (11,20,23,25,26,28,29,32-35,37) standing (12 studies), (11,19,20,22,26,27,29,32,34-37) passive mobilization (five studies), (26,28,29,30,37) resistance exercises (four studies), (23,34-36) positioning in bed (one study), (21) stretching (one study), (34) and functional electrical stimulation (FES) of the lower limb muscles combined with cycling (one study). (31) In addition, 93 patients from 11 studies (11,19,20,22,26,27,32,34-37) walked during ECMO support. Keibun (24) reported that the intervention group (IG) (n = 10) underwent PT + VV ECMO.…”

“…Among the 20 selected studies, 12 studies (11,22,25,27,29-34,36,37) did not report complications from PT combined with ECMO. Carswell et al (20) reported that there was a decrease in peripheral oxygen saturation or vertigo during mobilization in some patients, but recovery at rest was rapid.…”

Reducing hospital‐acquired pressure ulcers using bundle methodology in pediatric and neonatal patients receiving extracorporeal membrane oxygenation therapy: An integrative review and call to action

“…Knowing that the scientific literature has described apprehension of physicians and nurses to reposition patients on ECMO, nurses caring for these patients who aim to implement a HAPU prevention bundle inclusive of a repositioning element would look to the literature to identify any barriers to implementation in this specific population (Clements et al., ; Dennis et al., ; Morris, 2007; Stiller, 2007; Institute of Medicine, ). Of the seven studies evaluated in this review, none identified or explored barriers to implementing care bundle methodology as a HAPU prevention strategy in the pediatric and neonatal ECMO population.…”

“…In 2014, the Children's Hospitals Solutions for Patient Safety, a collaborative of over 80 children's hospitals whose mission is to eliminate serious patient harm, recommended a specific bundle of evidence-based interventions to prevent PUs in hospitalized children (Children's Hospital Association, 2015;Children's Hospitals Solutions for Patient Safety, 2014). Patient positioning is an important element of the recommended care bundle, and yet apprehension of nurses and physicians to reposition patients while on ECMO has been documented in the literature, citing decannulation, hemodynamic instability, availability of staff and equipment, the size of the patient, and the level of pain or discomfort as reasons of concern (Clements, Moore, Tribble, & Blake, 2014;Dennis et al, 2013) Yet, even in this highly at-risk population, stage 3 and 4 HAPUs are considered to be preventable complications of care (National Quality Forum, 2011). Schindler et al (2011) describe the role of skin care champions as integral to the success of implementing bundle methodology to prevent PUs in the general pediatric critical care population, in accordance with the "teamwork" and "reliable use" characteristics inherent to the success of bundle methodology (Children's Hospitals Solutions for Patient Safety, 2014).…”