| Autor: |
Abrams D; Division of Pulmonary, Allergy, and Critical Care., Madahar P; Division of Pulmonary, Allergy, and Critical Care., Eckhardt CM; Division of Pulmonary, Allergy, and Critical Care., Short B; Division of Pulmonary, Allergy, and Critical Care., Yip NH; Division of Pulmonary, Allergy, and Critical Care., Parekh M; Division of Pulmonary, Allergy, and Critical Care., Serra A; Division of Pulmonary, Allergy, and Critical Care., Dubois RL; Department of Surgery., Saleem D; Department of Medicine., Agerstrand C; Division of Pulmonary, Allergy, and Critical Care., Scala P; Department of Rehabilitation Medicine, and., Benvenuto L; Division of Pulmonary, Allergy, and Critical Care., Arcasoy SM; Division of Pulmonary, Allergy, and Critical Care., Sonett JR; Section of Thoracic Surgery, Department of Surgery., Takeda K; Division of Cardiac, Vascular and Thoracic Surgery, Department of Surgery, and., Meier A; Division of Pulmonary, Allergy, and Critical Care., Beck J; Clinical Perfusion and Anesthesia Support Services, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York., Ryan P; Department of Nursing, NewYork-Presbyterian Hospital, New York, New York., Fan E; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.; Department of Medicine, Division of Respirology, University Health Network and Sinai Health System, Toronto General Hospital, Toronto, Ontario, Canada., Hodgson CL; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia.; Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia; and., Bacchetta M; Departments of Thoracic and Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Brodie D; Division of Pulmonary, Allergy, and Critical Care. |
| Abstrakt: |
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. |
