Edelson J B, Wooster L, Huang J, Wang Z, Connelly J, Rossano J, O'Connor M, Mavroudis C D, Eichner J R, Gaynor J W, DeWitt A G, Evans S H, Edwards J, Wittlieb-Weber C A, Lin K Y, Lane-Fall M, Maeda K
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.
JHLT Open. 2024 Jan 19;4:100057. doi: 10.1016/j.jhlto.2024.100057. eCollection 2024 May.
The importance of physical rehabilitation in optimizing outcomes in critically ill patients is recognized. However, the frequency and benefit of mobilization in pediatric patients undergoing veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) are unclear. This study evaluates a cohort of pediatric VA-ECMO patients to characterize the spectrum of mobility and evaluate associations of mobilization with clinical outcomes.
We analyzed 688 patients (8-18 years) who underwent primary ECMO runs and had mobilization data collected in the Extracorporeal Life Support Organization Registry. Demographics, pre-ECMO support, location and duration of support, and outcomes, including survival to hospital discharge, heart transplant, and ECMO-related complications, were collected. Propensity score modeling was performed with entropy weighting to compare outcomes between mobile and nonmobile patients.
Of the 688 patients included, 10% achieved some degree of mobility (69/688); the majority of those exercised in bed. After propensity score matching, mobility was associated with an increased likelihood of being discharged alive (odds ratio (OR) 1.16, 95% cardiac index (CI) 1.04, 1.30) and receiving a heart transplant (OR 1.15, 95% CI 1.02, 1.29), and a lower likelihood of dying on ECMO (OR 0.90, 95% CI 0.81, 1.00). There was no association between mobility and ECMO being discontinued due to complication (OR 1.03, 95% CI 0.97, 1.10).
Mobilization in a pediatric VA-ECMO cohort was achieved by 1/10 patients, is associated with heart transplant and survival to hospital discharge, and is not associated with ECMO-related adverse events. Mobility in certain pediatric VA-ECMO patients is feasible and may represent an opportunity to improve outcomes.
身体康复对优化重症患者的治疗效果的重要性已得到认可。然而，在接受静脉 - 动脉（VA）体外膜肺氧合（ECMO）治疗的儿科患者中，活动的频率和益处尚不清楚。本研究评估了一组儿科VA - ECMO患者，以描述其活动范围，并评估活动与临床结局之间的关联。
我们分析了688例年龄在8至18岁之间接受初次ECMO治疗且在体外生命支持组织登记处收集了活动数据的患者。收集了人口统计学资料、ECMO治疗前的支持情况、支持的地点和持续时间以及结局，包括出院存活、心脏移植和ECMO相关并发症。采用熵加权法进行倾向评分建模，以比较活动患者和非活动患者的结局。
在纳入的688例患者中，10%实现了一定程度的活动（69/688）；其中大多数在床上进行活动。倾向评分匹配后，活动与出院存活（优势比（OR）1.16，95%可信区间（CI）1.04，1.30）和接受心脏移植（OR 1.15，95%CI 1.02，1.29）的可能性增加相关，而在ECMO治疗期间死亡的可能性较低（OR 0.90，95%CI 0.81，1.00）。活动与因并发症而停止ECMO治疗之间无关联（OR 1.03，95%CI 0.97，1.10）。
在儿科VA - ECMO队列中，1/10的患者实现了活动，这与心脏移植和出院存活相关，且与ECMO相关不良事件无关。某些儿科VA - ECMO患者的活动是可行的，可能代表了改善结局的一个机会。
