Kanellou Vasiliki, Kaliarntas Konstantinos, Dounavi Despoina Myrto, Patsaki Irini, Kalpaxis Dimitrios, Kourek Christos, Dimopoulos Stavros
Department of Physiotherapy, General Hospital of Nikea, Nikea 18450, Attikí, Greece.
Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patra 26334, Dytikí Elláda, Greece.
World J Cardiol. 2025 Aug 26;17(8):107811. doi: 10.4330/wjc.v17.i8.107811.
Extracorporeal membrane oxygenation (ECMO) is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments. Patients that are supported with veno-arterial ECMO (VA-ECMO) are considered very-high risk patients to participate in any type of physical therapy (PT) or mobilization. However, cumulative evidence suggests that early mobilization of critically ill patients is feasible, safe, and efficient under certain circumstances.
To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.
This is a scoping review that used systematic electronic literature searches (from inception until January 2025) on MEDLINE (PubMed), PEDro, DynaMed, CINAHL, Scopus, Science direct and Hellenic Academic Libraries. Snowball searching method was also applied. Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT, published in English and utilized any primary evidence study design. Studies on children, animals and patients placed on any other ECMO, secondary evidence, and 'grey' literature were excluded.
A total of 316 articles were retrieved and 13 were included in the study. Of those, 1 study was a randomized control trial, 4 retrospective studies, 4 retrospective cohort studies, 1 case series and 3 case reports. The sample size of the included studies ranged from 1 to 104 VA-ECMO patients, who were ambulated or received PT interventions, and mobilization frequency ranged from 2 per day to 4 per week. Mobilization of VA-ECMO patients seems to be safe regardless the cannula's position. PT and early mobilization were associated with better weaning from mechanical ventilation, gradual reduction of inotropes and functional capacity improvement after ECMO discharge.
Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times. High quality research on early mobilization in VA-ECMO patients is warranted.
体外膜肺氧合（ECMO）主要应用于对现有传统治疗无反应的严重心肺功能衰竭患者。接受静脉-动脉ECMO（VA-ECMO）支持的患者被认为是参与任何类型物理治疗（PT）或活动的极高风险患者。然而，越来越多的证据表明，在某些情况下，危重症患者的早期活动是可行、安全且有效的。
总结早期活动和物理治疗对VA-ECMO患者影响的现有证据。
这是一项范围综述，通过对MEDLINE（PubMed）、PEDro、DynaMed、CINAHL、Scopus、Science direct和希腊学术图书馆进行系统的电子文献检索（从数据库建立至2025年1月）。还应用了滚雪球搜索法。符合条件的研究包括那些报告接受VA-ECMO治疗且参与早期活动或PT的患者的研究，研究以英文发表，并采用任何原始证据研究设计。排除关于儿童、动物以及接受其他任何ECMO治疗的患者的研究、二次证据和“灰色”文献。
共检索到316篇文章，13篇被纳入研究。其中，1项为随机对照试验，4项为回顾性研究，4项为回顾性队列研究，1项为病例系列研究，3项为病例报告。纳入研究的样本量为1至104例接受VA-ECMO治疗的患者，这些患者进行了活动或接受了PT干预，活动频率为每天2次至每周4次。无论插管位置如何，VA-ECMO患者的活动似乎都是安全的。PT和早期活动与机械通气脱机情况改善、血管活性药物逐渐减少以及ECMO出院后功能能力提高相关。
VA-ECMO患者的早期活动似乎是安全的，并且可能有助于减少血管收缩剂的使用并加快康复时间。有必要对VA-ECMO患者的早期活动进行高质量研究。
