Pediatric patients on veno-arterial extracorporeal membrane oxygenation undergoing cardiac rehabilitation have better outcomes

Abstract

BackgroundThe importance of physical rehabilitation in optimizing outcomes in critically ill patients is recognized. However, the frequency and benefit of mobilization in pediatric patients undergoing veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is unclear. This study evaluates a cohort of pediatric VA-ECMO patients to characterize the spectrum of mobility and evaluate associations of mobilization with clinical outcomes. MethodsWe analyzed 688 patients (8-18yrs) who underwent primary ECMO runs and had mobilization data collected in the Extracorporeal Life Support Organization (ELSO) Registry. Demographics, pre-ECMO support, location and duration of support, and outcomes including survival to hospital discharge, heart transplant, and ECMO related complications were collected. Propensity score modeling was performed with entropy weighting to compare outcomes between mobile and non-mobile patients. ResultsOf the 688 patients included, 10% achieved some degree of mobility (69/688); the majority of those exercised in bed. After propensity score matching, mobility was associated with an increased likelihood of being discharged alive (OR 1.16, 95% CI 1.04, 1.30) and receiving a heart transplant (OR 1.15, 95% CI 1.02, 1.29), and a lower likelihood of dying on ECMO (OR 0.90, 95% CI 0.81, 1.00). There was no association between mobility and ECMO being discontinued due to complication (OR, 1.03 95% CI 0.97, 1.10). ConclusionMobilization in a pediatric VA-ECMO cohort was achieved by 1/10 patients, is associated with heart transplant and survival to hospital discharge and is not associated with ECMO related adverse events. Mobility in certain pediatric VA-ECMO patients is feasible and may represent an opportunity to improve outcomes.