Outcomes of Mobilization of Patients on Veno-Arterial Extracorporeal Membrane Oxygenation

Abstract

<h3>Purpose</h3> Weakness and deconditioning are common findings in those with critical illness. Mobilization is associated with improved outcomes.VA-ECMO is the highest level of mechanical circulatory support (MCS) offered with bypass of the heart and lungs. Mortality is approximately 60% for those on VA-ECMO support. This retrospective study aims to present characteristics and outcomes associated with mobilization on VA-ECMO. <h3>Methods</h3> Patients were identified at our quarternary care system. Seventy-five consecutive were cannulated with VA-ECMO support for cardiogenic shock over a three year period. Seven patients were mobilized while on VA-ECMO. Baseline characteristics, fraility, ICU Mobility scales, and standard outcomes as defined by the Extracorporeal Life Support Organization were obtained. <h3>Results</h3> The mobilized group was younger (39.7 ± 17.7 years vs 55.3 ± 14.6 years; p = 0.010) and were more likely to have normal body mass index (22.4 ± 5.1 kg/m² vs 28.2 ± 6.5; p = 0.025). All patients mobilized were male (100% vs 70.5%). Mobilized patients had support cannulas placed in the femoral position with 6/7 (85.7%) having ipsilateral venous and femoral access. Five (71.4%) patients had percutaneous devices placed in the contralateral femoral artery or left axillary artery. Five (71.4%) patients were cannulated peripherally. All patients mobilized on VA-ECMO survived to discharge while 29.4% of patients not mobilized survived to discharge (p = 0.008). Vascular complications between mobilized (0%) and non-mobilized patients (7; 10.9%) were non-significant (p = 0.584). <h3>Conclusion</h3> Patients mobilized on VA-ECMO are more likely to survive than those who were not mobilized. Complex patients with the presence of MCS devices can be mobilized. Thorough multidisciplinary planning must be taken to ensure that access sites are secure and patients that are appropriate for extubation are extubated in a timely manner while on VA-ECMO. Thought should be given to cannulation location and insertion depth and how this will affect a patient ability to mobilize. Patients with VA-ECMO as a bridge to transplant may introduce selection bias and may skew safety profiles. Ultimately, this study is limited in its single center, retrospective nature, but further prospective trials should be utilized to help identify appropriate candidates for mobilization while on VA-ECMO support for cardiogenic shock.