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Feasibility of Early Mobility During Pediatric Extracorporeal Membrane Oxygenation: Single-Center Retrospective
Alyssa Mueller1,2, Brian Bridges3, Melissa Danko4
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Insights
Early mobility (EM) protocols are feasible in pediatric intensive care unit (PICU) patients on extracorporeal membrane oxygenation (ECMO). This study shows high rates of mobilization and low intolerance, supporting progressive EM in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation medicine
- Extracorporeal membrane oxygenation
Background:
- Early mobility (EM) protocols are increasingly implemented in pediatric intensive care units (PICUs).
- The feasibility of EM in patients requiring extracorporeal membrane oxygenation (ECMO) is less understood.
Purpose of the Study:
- To assess the feasibility of a progressive early mobility (EM) protocol for pediatric patients supported by ECMO.
- To determine mobilization rates, activity levels, and safety of EM in this population.
Main Methods:
- Retrospective analysis of data from a single-center PICU over a 6-year period (June 2018-July 2024).
- Inclusion of all pediatric patients (0-18 years) on ECMO who underwent the unit-wide EM protocol.
- Data collected on EM sessions, activity levels achieved, signs of intolerance, and adverse events.
Main Results:
- 84% of eligible patients (52/62) underwent EM while on ECMO.
- 35% of mobilized patients achieved moderate to vigorous activity (Level II/III).
- EM sessions had a low rate of intolerance (6.1%) and no serious adverse events directly attributed to the intervention.
Conclusions:
- A progressive multidisciplinary EM protocol is feasible in PICU patients requiring ECMO support.
- The protocol demonstrates acceptable safety and tolerability in this critically ill population.
- This study provides valuable local data on EM implementation during ECMO.
Objectives:
To describe the feasibility of a progressive early mobility (EM) protocol in PICU patients requiring support with extracorporeal membrane oxygenation (ECMO).
Design:
Single-center retrospective analysis of data from the 6-year period post-implementation of an EM protocol.
Setting:
Medical-surgical PICU within a standalone academic children's hospital in the United States.
Patients:
All PICU patients 0-18 years old supported on ECMO post-implementation of a unit-wide EM protocol (from June 2018 to July 2024).
Interventions:
None.
Measurements And Main Results:
Sixty-two patients met inclusion criteria. Overall, 52 of 62 patients (84%) underwent EM while on ECMO, with 18 of 52 patients (35%) undergoing EM achieving at least level II or III activity. Of 23 long-duration ECMO patients (i.e., requiring ECMO for ≥ 10 d), 14 of 23 patients achieved level II or III activity. Of 297 unique EM sessions, signs of intolerance occurred in 18 of 297 sessions (6.1% [95% CI, 3.9-9.4%]); these occurred in ten of 52 unique patients (19.2% [95% CI, 10.8-31.9%). There were no serious adverse events attributable to EM (0/297; upper limit of the 95% CI, 1.0%). However, an EM session in one patient was followed by recognition of neurologic changes on examination and a new diagnosis of stroke.
Conclusions:
Over 6 years in our PICU (2018-2024), we found that implementation of a progressive multidisciplinary EM protocol during ECMO was feasible. Our data also provide local metrics for rate of mobilization and level of activity achieved, signs of intolerance, and serious adverse events.
