Early Mobilization during Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure in Adults: Factors Associated with Intensity of Treatment
Darryl Abrams, Purnema Madahar, Christina M. Eckhardt, Briana Short, Natalie H. Yip, Madhavi Parekh, Alexis Serra, Richard L. Dubois, Danial Saleem, Cara Agerstrand, Peter Scala, Luke Benvenuto, Selim M. Arcasoy, Joshua R. Sonett, Koji Takeda, Anne Meier, James Beck, Patrick Ryan, Eddy Fan, Carol L. Hodgson, Matthew Bacchetta, Daniel Brodie
Abstract
Abstract Rationale Early mobilization of extracorporeal membrane oxygenation (ECMO)-supported patients is increasingly common, but it remains unknown whether there are factors predictive of achieving higher intensity mobilization among those able to participate in physical therapy. Additionally, data regarding the safety and feasibility of early mobilization with femoral cannulation, particularly ambulation, are sparse. Objectives To determine whether there are factors associated with achieving out-of-bed versus in-bed physical therapy in ECMO-supported patients participating in physical therapy, and whether mobilization with femoral cannulation is safe and feasible. Methods This large, single-center, retrospective study evaluated adult patients who performed active physical therapy while receiving ECMO. Mixed effects modeling was used to identify predictors of out-of-bed versus in-bed activity. Rates of mobilization with femoral cannulation and adverse events were also reported. Results Between April 2009 and January 2020, 511 patients were supported with ECMO in a single medical intensive care unit, of whom 177 (35%) underwent active physical therapy and were included in the analysis, including 124 of 141 (88%) bridge to lung transplantation and 53 of 370 (14%) bridge to recovery. These 177 patients accounted for 2,706 active physical therapy sessions, with 138 patients (78%) achieving out-of-bed activity. In total, 108 (61%) patients ambulated (1,284 sessions), 34 of whom had femoral cannulae (250 sessions). Bridge-to-transplant (odds ratio [OR], 17.2; 95% confidence interval [CI], 4.12–72.1), venovenous ECMO (OR, 2.83; 95% CI, 1.29–6.22), later cannulation year (OR, 1.65; 95% CI, 1.37–1.98) and higher Charlson comorbidity index (OR, 1.53; 95% CI, 1.07–2.19) were associated with increased odds of achieving out-of-bed versus in-bed physical therapy, whereas invasive mechanical ventilation (OR, 0.11; 95% CI, 0.05–0.25) and femoral cannulation (OR, 0.19; 95% CI, 0.04–0.92) were associated with decreased odds of performing out-of-bed activities. Adverse events occurred in 2% of sessions. Conclusions Several patient- and ECMO-related factors were associated with achieving higher intensity of early mobilization in patients participating in rehabilitation. Physical therapy with femoral cannulation was safe and feasible, and complications related to mobilization were uncommon.