title: Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study.
abstract: BACKGROUND
  Critical illness is a well-recognized cause of neuromuscular weakness and impaired physical functioning. Physical therapy (PT) has been demonstrated to be safe and effective for critically ill patients. The impact of such an intervention on patients receiving extracorporeal membrane oxygenation (ECMO) has not been well characterized. We describe the feasibility and impact of active PT on ECMO patients.
  
  
  METHODS
  We performed a retrospective cohort study of 100 consecutive patients receiving ECMO in the medical intensive care unit of a university hospital.
  
  
  RESULTS
  Of the 100 patients receiving ECMO, 35 (35%) participated in active PT; 19 as bridge to transplant and 16 as bridge to recovery. Duration of ECMO was 14.3 ± 10.9 days. Patients received 7.2 ± 6.5 PT sessions while on ECMO. During PT sessions, 18 patients (51%) ambulated (median distance 175 feet, range 4 to 2,800) and 9 patients were on vasopressors. Whilst receiving ECMO, 23 patients were liberated from invasive mechanical ventilation. Of the 16 bridge to recovery patients, 14 (88%) survived to discharge; 10 bridge to transplant patients (53%) survived to transplantation, with 9 (90%) surviving to discharge. Of the 23 survivors, 13 (57%) went directly home, 8 (35%) went to acute rehabilitation, and 2 (9%) went to subacute rehabilitation. There were no PT-related complications.
  
  
  CONCLUSIONS
  Active PT, including ambulation, can be achieved safely and reliably in ECMO patients when an experienced, multidisciplinary team is utilized. More research is needed to define the barriers to PT and the impact on survival and long-term functional, neurocognitive outcomes in this population.
authors.forename: Darryl
authors.initials: D
authors.lastname: Abrams
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Javidfar
authors.forename: Erica
authors.initials: E
authors.lastname: Farrand
authors.forename: Linda B
authors.initials: LB
authors.lastname: Mongero
authors.forename: Cara L
authors.initials: CL
authors.lastname: Agerstrand
authors.forename: Patrick
authors.initials: P
authors.lastname: Ryan
authors.forename: David
authors.initials: D
authors.lastname: Zemmel
authors.forename: Keri
authors.initials: K
authors.lastname: Galuskin
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Morrone
authors.forename: Paul
authors.initials: P
authors.lastname: Boerem
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
mesh_terms: D016638:Critical Illness; D004434:Early Ambulation / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000534:rehabilitation*; D006801:Humans; D007362:Intensive Care Units; D026741:Physical Therapy Modalities; D012189:Retrospective Studies