title: Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.
abstract: BACKGROUND
  There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS).
  
  
  OBJECTIVE
  We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality.
  
  
  METHODS
  We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO.
  
  
  RESULTS
  Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy.
  
  
  CONCLUSIONS
  Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile.
authors.affiliation: 1 Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laveena
authors.initials: L
authors.lastname: Munshi
authors.affiliation: 2 Department of Anesthesiology and Critical Care Medicine, Yamagata University, Yamagata, Japan; and.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: 1 Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: DeBacker
authors.affiliation: 3 Department of Medicine, State University of New York Upstate Medical University, Syracuse, New York.
authors.forename: Ravi
authors.initials: R
authors.lastname: Doobay
authors.affiliation: 1 Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Teagan
authors.initials: T
authors.lastname: Telesnicki
authors.affiliation: 4 Department of Physiotherapy, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo
authors.affiliation: 4 Department of Physiotherapy, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Cote
authors.affiliation: 5 Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cypel
authors.affiliation: 5 Division of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.affiliation: 1 Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.|6 Interdepartmental Division of Critical Care Medicine, Department of Physiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.affiliation: 1 Interdepartmental Division of Critical Care Medicine, Department of Medicine, Mount Sinai Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies
keywords: acute respiratory distress syndrome; extracorporeal membrane oxygenation; intensive care unit; physiotherapy; rehabilitation