Mobility Levels With Physical Rehabilitation Delivered During and After Extracorporeal Membrane Oxygenation: A Marker of Illness Severity or an Indication of Recovery?

Abstract

Objective The aims of this study were to determine whether physical rehabilitation intervention for patients who required extracorporeal membrane oxygenation (ECMO) is associated with clinical outcomes and to assess whether the patient mobility response over initial rehabilitation sessions early in the intensive care unit (ICU) course predicts or is associated with survival, lengths of stay, discharge disposition, and 30-day readmissions. Methods This study was a 10-year retrospective practice analysis of adults who were critically ill and required ECMO for >72 hours in the cardiothoracic ICU at an academic medical center. Physical rehabilitation implemented during or following the initiation of ECMO was quantified on the basis of timing, frequency, and change in mobility level in response to the intervention over the first 4 consecutive sessions. The primary dependent outcome was in-hospital mortality. Secondary outcomes included 30-day readmission and discharge disposition ranked on an ordinal scale. Results Three hundred fifteen patients (mean age = 50 y [SD = 15 y]; 63% men; mean Sequential Organ Failure Assessment score = 11.6 [SD = 3.3]) met the inclusion criteria. Two hundred eighteen patients (69%) received at least 1 physical rehabilitation session while requiring ECMO, 70 (22%) received rehabilitation after ECMO was discontinued, and 27 (9%) never received rehabilitation. Patients discharged alive achieved higher mobility levels and had a steeper, more positive rate of change in mobility over the first 4 sessions than patients who died in the hospital (2.8 versus 0.38; t199 = 8.24). Those who received rehabilitation and achieved the milestones of sitting on the edge of the bed and walking for>45 m were more likely to survive (47% versus 13%; χ2 = 156) than those who did not (26% versus 3.5%; χ2 = 80). Conclusion A positive rate of change in mobility and the ability to achieve mobility milestones with rehabilitation were associated with improved clinical outcomes. Impact A patient’s mobility response to physical rehabilitation early in the ICU course is an important indicator of illness and should be used with clinical presentation to guide clinical decision making and predict outcomes.

Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU

“…This shortcoming was addressed by Mayer et al, who demonstrated that ECMO patients achieving higher mobility levels had a better chance to survive [ 42 ]. However, the authors raised the question of whether early mobilization actually improves outcome and whether the more favorable disease course does not allow mobilization with more rapid progression to higher levels [ 42 ]. Therefore, we adjusted mobilization parameters for disease severity, age and other influencing factors.…”

Cardiovascular and Pulmonary Research: The Year (2022) in Review

“…5 The receipt of this rehabilitation was not found to be significant to survival or 30-day hospital admission. 5 Early rehabilitation occurred approximately 25% of the time for persons with ECMO; i.e. within 10 days of ECMO initiation.…”

“…Results of this study showed that only a small number of patients on ECMO did not receive rehabilitation during their hospitalization. 5 These patients were significantly more sick, had greater sedation levels, and were more likely to have VA ECMO. 5 Most patients received rehabilitation while in the ICU regardless of ECMO presence.…”

“…5 Most patients received rehabilitation while in the ICU regardless of ECMO presence. 5 The receipt of this rehabilitation was not found to be significant to survival or 30-day hospital admission. 5 Early rehabilitation occurred approximately 25% of the time for persons with ECMO; i.e.…”

“…Appropriate patient demographics were collected and revealed an appropriately diverse patient population that included venovenous (VV) and venoarterial (VA) ECMO circuitry using single or double lumen catheters. 5…”