Feasibility and Safety of Early Physical Therapy and Active Mobilization for Patients on Extracorporeal Membrane Oxygenation

Ko, Young-Jun; Cho, Yang Hyun; Park, Yun Hee; Lee, Sang‐Do; Suh, Gee Young; Yang, Jeong Hoon; Park, Chi-Min; Jeon, Kyeongman; Chung, Chi Ryang

doi:10.1097/mat.0000000000000239

Cited by 70 publications

(68 citation statements)

References 28 publications

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“…Recent expert recommendations on safety criteria for early mobilization mentioned that vasopressor use [38, 39], endotracheal intubation, RRT [38], or even life support devices like ECMO [40] should not be considered as contraindications for active mobilization. Despite that, besides the study of Pohlman et al [32] performing in-bed mobilization with maximal FiO 2 at 1.0 and vasoactive drug, no study has explored the safety of very early mobilization in critically ill patients on multiple support systems.…”

Section: Discussionmentioning

confidence: 99%

Teamwork enables high level of early mobilization in critically ill patients

Hickmann

Castanares-Zapatero

Bialais

et al. 2016

Ann. Intensive Care

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BackgroundEarly mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients.ResultsGeneral practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15–23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients’ refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients’ subjective perception of physical therapy was reported to be enjoyable.ConclusionsMobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0184-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Teamwork enables high level of early mobilization in critically ill patients

Hickmann

Castanares-Zapatero

Bialais

et al. 2016

Ann. Intensive Care

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“…The majority were sedated and mechanically ventilated for the duration of ECMO, including all subjects that required ECMO post lung transplant. Previous studies have reported that femoral cannulation, sedation and mechanical ventilation are barriers to the early mobilization of ECMO patients, 26,27 and there are no published studies to date describing the ambulation or out of bed rehabilitation of patients with femoral venoarterial ECMO. Over half of the subjects in our study underwent femoral venoarterial ECMO and required higher sedation levels than our protocol aims.…”

Section: Discussionmentioning

confidence: 99%

Physical Function in Subjects Requiring Extracorporeal Membrane Oxygenation Before or After Lung Transplantation

et al. 2017

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“…Ambulatory ECMO is helpful for conditioning and for assessing a patient's potential for recovery after transplantation (23). Ko and colleagues (24) showed that multiple physical therapy sessions including ambulatory ECMO are safe with the use of a mobilization screening protocol.…”

Section: Management Of Ecmomentioning

confidence: 99%