Background
Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe cardiopulmonary dysfunction. Despite its critical role, prolonged immobility during ECMO support can lead to ICU-acquired weakness, significantly impairing recovery. Early rehabilitation in the ICU has shown promise in mitigating these effects, but structured programs for ECMO patients remain understudied.
Study Design
This prospective single-center pilot study enrolled 20 adults on ECMO (mean age 47±15 years, 80% male, 95% venovenous ECMO). Participants received a daily regimen of morning mobility therapy with physical/occupational therapy (PT/OT), including tilt/verticalization, activities of daily living, and graded transitions (sitting, standing, ambulation). Afternoon sessions focused on resistance exercises supervised by a clinical exercise physiologist (≥5 days/week).
Key Findings
The program demonstrated high safety with only two minor, immediately resolved adverse events. Day-28 survival was 95%, with in-hospital survival at 85%. Among survivors, 56% were discharged home, and 44% showed increased BMI from admission to discharge. Daily therapy averaged 21 minutes for PT/OT, 30 minutes for resistance training, and 35 minutes of combined exercise. Longer session times were significantly associated with faster supine-to-sitting transitions (p=0.002) and increased repetitions in resistance exercises (p<0.001).
Expert Commentary
This study provides compelling evidence for the feasibility and safety of structured exercise during ECMO. The correlation between session duration and functional gains underscores the potential of early rehabilitation to enhance recovery. However, the pilot nature of the study calls for larger, controlled trials to confirm these findings and explore long-term outcomes.
Conclusion
Incorporating resistance training and verticalization into ECMO care is feasible and may improve functional performance. These findings advocate for integrating structured rehabilitation protocols into ECMO management, pending further research to validate benefits on recovery and long-term outcomes.
Funding and Registration
This study was conducted as a pilot without explicit mention of funding or clinical trial registration.
