The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review

Abstract

Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to the severity of their illness. Care is also required to maintain the position and integrity of the ECMO cannula. However, they experience a range of effects due to prolonged bed rest. This systematic review examined the possible effects of the early mobilization in patients on ECMO. The database PUBMED was searched by using appropriate keywords: “rehabilitation”, “mobilization”, “ECMO” and “extracorporeal membrane oxygenation”. The selection criteria for the article search were the following: (a) studies published in the last five years, (b) descriptive studies, (c) randomized studies, (d) published in the English language and (e) studies in adults. A total of 259 studies were found, 8 of which were finally selected. Most of the studies showed that early intensive physical rehabilitation related to a decrease in in-hospital stay and a reduction in the duration of mechanical ventilation and doses of vasopressors. In addition, improvements in the functional status and rate of mortality were observed along with a reduction in health care costs. Exercise training should be a fundamental part of the management of patients on ECMO.

Survival outcomes and mobilization during venovenous extracorporeal membrane oxygenation: a retrospective cohort study

“…This might suggest that a higher intensity of training is important to improve outcome. A meta-analysis of literature on mobilization on ECMO ( 36 ) suggested that more intense mobilization increases outcome. This observation can be strengthened by our data and fits to data suggesting that especially out of bed mobilization improves outcome ( 37 ).…”

Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation

“…It is now widely accepted that rehabilitation is a standard of care, and researchers may want to explore new directions in this field. Although several studies have shown that mobilization and exercise are possible for patients on ECMO support, 14,15,[23][24][25]27,28,48 their rehabilitative potential is still underestimated at present. 49 On the other hand, implementing early and active rehabilitation is a well-established concept in critically ill patients and ICU settings, although the definition of "early" and the dosage of mobilization remain controversial and uncertain.…”

“…3 On the other hand, deleterious effects of prolonged bed rest, such as muscle wasting, are widely documented in critical patients. 4 Although mobilization has been recognized as feasible and effective in acute settings, [5][6][7][8][9][10][11][12][13][14][15][16] dosage and timing are matters of continuing research.…”

“…[17][18][19][20][21][22] The first consensus document on physiotherapy for this class of patients was published in 2017, providing evidence-based support for rehabilitation professionals. 23 Since then, various studies have explored rehabilitation methods for patients undergoing ECMO, 14,15,[24][25][26][27] while a recent EuroELSO survey was designed to capture modalities and characteristics of the physiotherapeutic treatments currently provided in international ECMO settings. 28 Rehabilitation of patients on ECMO support involves a complex delivery of assessment procedures and techniques aiming at restoring or maintaining neuromuscular, cognitive and respiratory functions in an acute context of reduced or absent mobility of the person.…”

“…However, current information on the latest rehabilitative practices is limited, as previous reviews covered data up to October 2021, and some considered only patients on awake ECMO or with COVID-19. 15,24,25 Therefore, the present review aims to provide a concise overview of the latest findings on rehabilitation and highlight emerging rehabilitative trends in patients undergoing ECMO support.…”