Early Ambulation of Patients on Extracorporeal Membrane Oxygenator (ECMO)

Background: Evidence-based benefits of early progressive mobility for the patients in the ICU are well documented in the literature. However, this may pose a particular challenge in terms of safety and tolerance for the patients with end stage lung disease who are supported by veno-venous extracorporeal membrane oxygenation (V-V ECMO) and waiting for lung transplantation. ECMO restricts patient mobility, which lead to physical deconditioning that may further prolongs recovery. There are only few studies that report ambulating patients on ECMO as a bridge for lung transplantation.

Purpose: Describe an early safe progressive mobility program for V-V ECMO patients in a Surgical ICU at a large academic medical during the ABCDEF Bundle quality improvement project.

Method: We identified patients who were supported on V-V ECMO from January 2016 to April 2017. An interdisciplinary team members consisting of primary nurse, perfusionist, respiratory therapist, physical therapist, nurse practitioner and the intensivist were engaged to ensure the eligibility and the safety of the patients before ambulation. Team implemented the E element (Early Mobility and Exercise) of the ABCDEF bundle, by identifying strategies for successful implementation of early mobilization program for these patients.

Results: Total of six patients was ambulated on V-V ECMO. Early progressive mobility was started with the involvement of the interdisciplinary team. Eligibility of each patient was evaluated for ambulation and discussed during the daily rounds. Patient mobility safety screening was performed before initiation of the ambulation. In addition, a strong physical therapy mobility program enhanced staff commitment to consistently promote early mobility. In these six cases, there were no adverse events related to ambulation of these patients.

Conclusion: Ambulation with V-V ECMO was safely performed on all six patients. The key elements for the successful implementation of ambulation are interdisciplinary team engagement and safety screenings. The team is in the process of developing early mobility protocol. Future studies should explore the effects of ambulation of V-V ECMO patients on physical and psychological outcome measures.