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Randomized Controlled Trial
. 2021 May;34(3):217-225.
doi: 10.1016/j.aucc.2020.07.008. Epub 2020 Oct 7.

Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial

K Hayes  1 , A E Holland  2 , V A Pellegrino  3 , M Young  4 , E Paul  5 , C L Hodgson  6
Affiliations
Randomized Controlled Trial

Early rehabilitation during extracorporeal membrane oxygenation has minimal impact on physiological parameters: A pilot randomised controlled trial

K Hayes et al. Aust Crit Care. 2021 May.

Abstract

Background: Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to their severity of illness along with the care required to maintain the position and integrity of the ECMO cannula. Many patients on ECMO receive passive exercises, and rehabilitation is often delayed owing to medical instability, with a high proportion of patients demonstrating severe muscle weakness. The physiological effects of an intensive rehabilitation program started early after ECMO commencement remain unknown.

Objectives: The primary objective of this study was to describe the respiratory and haemodynamic effects of early intensive rehabilitation compared with standard care physiotherapy over a 7-d period in patients requiring ECMO.

Methods: This was a physiological substudy of a multicentre randomised controlled trial conducted in one tertiary referral hospital. Consecutive adult patients undergoing ECMO were recruited. Respiratory and haemodynamic parameters, along with ECMO settings, were recorded 30 min before and after each session and continuously during the session. In addition, the minimum and maximum values for these parameters were recorded outside of the rehabilitation or standard care sessions for each 24-h period over the 7 d. The number of minutes of exercise per session was recorded.

Results: Fifteen patients (mean age = 51.5 ± standard deviation of 14.3 y, 80% men) received ECMO. There was no difference between the groups for any of the respiratory, haemodynamic, or ECMO parameters. The minimum and maximum values for each parameter were recorded outside of the rehabilitation or standard care sessions. The intensive rehabilitation group (n = 7) spent more time exercising per session than the standard care group (n = 8) (mean = 28.7 versus 4.2 min, p < 0.0001). Three patients (43%) in the intensive rehabilitation group versus none in the standard care group mobilised out of bed during ECMO.

Conclusions: In summary, early intensive rehabilitation of patients on ECMO had minimal effect on physiological parameters.

Keywords: Exercise; Extracorporeal membrane oxygenation; Intensive care units; Physical therapy modalities.

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Conflict of interest statement

Conflict of interest Professor Hodgson is supported by a Future Leader Fellowship from the National Heart Foundation of Australia (award ID:101168). Associate professor Pellegrino received travel and accommodation support for a symposium in April 2018 from Xenios. Neither body played a role in initiation and design of the study, interpretation of results, or publication of this study. None of the other authors have conflicts to disclose.

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