Characteristics and Progression of Rehabilitation in Patients Undergoing Extracorporeal Membrane Oxygenation: A...

Early rehabilitation during extracorporeal membrane oxygenation (ECMO) support is increasingly implemented, yet real-world data describing rehabilitation progression remain limited. This study aimed to characterize rehabilitation patterns during ECMO and descriptively compare physical activity trajectories among patients managed as bridge to transplantation (BTT), bridge to recovery (BTR), and ECMO waitlist death (EWD).

Adult patients (≥18 years) admitted to a medical ICU between May 2018 and November 2023 who received ECMO for ≥24 h and participated in at least one active rehabilitation session were retrospectively analyzed. Rehabilitation candidacy, weekly rehabilitation frequency, session interruptions, and highest physical activity level were recorded. Between-group comparisons were exploratory.

A total of 111 patients were included. In ECMO week 1, 58% of rehabilitation candidates received active rehabilitation, increasing to approximately 80% during weeks 2-4. Most patients completed or discontinued rehabilitation within 4 weeks because of transplantation, clinical recovery, or deterioration. Weekly rehabilitation frequency differed among groups and was highest in the BTT group (mean, 4.2 sessions/week; p < 0.05). Other activity-level comparisons among groups were not statistically significant. Sitting-level activities were consistently achievable during ECMO support, including support beyond 4 weeks. Among ICU survivors, activity levels were maintained through decannulation and improved afterward.

Among selected patients who entered an active ECMO rehabilitation pathway, rehabilitation was commonly initiated within 2 weeks and completed or discontinued within 4 weeks. Edge-of-bed sitting was generally achievable throughout ECMO support.