Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review

Area of Science:

• Critical Care Medicine
• Rehabilitation Science
• Cardiopulmonary Support

Background:

• Extracorporeal life support (ECLS) provides vital organ support but can lead to deconditioning.
• The role of physical rehabilitation and/or mobilization (PR&M) in ECLS patients is not well-established.
• Evidence synthesis is needed to guide clinical practice regarding PR&M in ECLS.

Approach:

• Systematic review of 17 studies involving 996 adult patients receiving ECLS.
• Searched seven electronic databases without language restrictions.
• Assessed risk of bias and certainty of evidence using established frameworks (Cochrane, GRADE).

Key Points:

• High-intensity/active PR&M demonstrated an uncertain effect on mortality, ventilation duration, and length of stay.
• Safety outcomes, including bleeding and circuit dysfunction, also showed uncertain effects with high-intensity PR&M.
• Evidence certainty was very low due to significant risk of bias and imprecision across studies.

Conclusions:

• Current evidence suggests an uncertain impact of high-intensity PR&M on patient outcomes and safety in the ECLS population.
• While some data suggest potential benefits in other ICU settings, robust evidence for ECLS patients is lacking.
• High-quality randomized controlled trials are essential to determine the true benefits and risks of PR&M in ECLS.