Feasibility and Safety of Mobilization of Patients with Extracorporeal Membrane Oxygenation - a Prospective Cohort Study

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) is used as temporary life support in patients with potential reversible respiratory or cardiac failure. Physical therapy of these critically ill patients provides many benefits including prevention of muscle atrophy and maintenance of fitness. The purpose of our study was to evaluate feasibility and safety of mobilization of patients with extracorporeal membrane oxygenation (ECMO) as part of routine intensive case unit (ICU) physical therapist (PT) practice. Methods: A total of 115 adult patients (67% male, mean age 57 years) were treated with an extracorporeal life support (ECLS) in our center. Different types of ECLS were used: va-ECMO (72), vv-ECMO (23), vv- ECCO2R (21), va-ECCO2R (9) and RVAD (7). Twelve patients (10,4%) were awake on ELCS. Mean duration on ECLS was 11 days and the most common site for arterial and venous cannulation were the femoral vessels (93,7%). Results: Over a 12-month study period every patient was at least once mobilized. During ECLS treatment, mobilization of patients was conducted every fourth day on average. In total, there were 332 PT interventions with a median duration of patient mobilization of 131 minutes. Mobilization to the edge of bed was performed during 45 PT interventions (14%), standing was reached with 22 patients (7%) and two patients (0,6%) walked down the corridor. During 263 PT interventions (79%) the patient was mobilized into an armchair. On average, blood flow declined 0,1 l/min during PT intervention. Also, a drop of mean arterial pressure (-14mmHg) and of oxygen saturation (- 6%) was observed. Reason for cancellation of PT intervention included patient's sedation (63%), reduced clinical status (20%), coma (4%), shortage of staff (4%), hemodynamic and respiratory instability (5%), agitation (3%) and others (1%). Following PT practice, bleeding occurred in 13 patients (3,9%) and low-flow-alarm was recognized in 12 patients (3,6%). In one case, PT intervention caused dislocation of an ECMO cannula and re-implantation was required. Conclusions: Mobilization of patients with ECMO is feasible and safe during PT practice. In less than 0,3% of PT interventions severe complications were observed including dislocation of an ECMO cannula. However, evidence on this topic is low and further studies of potential benefits of PT interventions in ECMO patients are required.