Division of Pulmonary, Allergy, and Critical Care.
Department of Surgery.
Ann Am Thorac Soc. 2022 Jan;19(1):90-98. doi: 10.1513/AnnalsATS.202102-151OC.
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. 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. 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. 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. 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.
体外膜肺氧合 (ECMO) 支持患者的早期活动越来越常见，但尚不清楚在能够参加物理治疗的患者中，是否存在可预测更高强度活动的因素。此外，关于股静脉置管早期活动的安全性和可行性的数据也很少。
本研究旨在确定在接受物理治疗的 ECMO 支持患者中，是否存在与离床与卧床物理治疗相关的因素，以及股静脉置管的活动是否安全可行。
这项大型单中心回顾性研究评估了在重症监护病房接受 ECMO 支持的接受主动物理治疗的成年患者。使用混合效应模型确定了离床与卧床活动的预测因素。还报告了股静脉置管的活动率和不良事件。
2009 年 4 月至 2020 年 1 月，在一个医疗重症监护病房中有 511 例患者接受 ECMO 支持，其中 177 例（35%）接受了主动物理治疗并纳入分析，包括 141 例（88%）桥接肺移植和 370 例（14%）桥接恢复。这 177 例患者共进行了 2706 次主动物理治疗，其中 138 例（78%）达到离床活动。总共 108 例（61%）患者能够离床活动（1284 次），其中 34 例有股静脉置管（250 次）。桥接移植（比值比[OR]，17.2；95%置信区间[CI]，4.12-72.1）、静脉-静脉 ECMO（OR，2.83；95%CI，1.29-6.22）、较晚的置管年份（OR，1.65；95%CI，1.37-1.98）和较高的 Charlson 合并症指数（OR，1.53；95%CI，1.07-2.19）与离床与卧床物理治疗相关，而有创机械通气（OR，0.11；95%CI，0.05-0.25）和股静脉置管（OR，0.19；95%CI，0.04-0.92）与离床活动的可能性降低相关。2%的治疗过程中发生了不良事件。
患者和 ECMO 相关的几个因素与接受康复治疗的患者实现更高强度的早期活动相关。股静脉置管的物理治疗是安全可行的，与活动相关的并发症并不常见。
