Awake extracorporeal membrane oxygenation (aECMO) has emerged as a strategy to minimise physical and neurocognitive complications of a prolonged intensive care admission. However, the safety and implementation in critically ill children remains a challenge and is understudied.

This case study describes a 7-year-old female child with severe respiratory failure managed with venovenous ECMO and the use of PICUStars Liberation Bundle to support aECMO and early rehabilitation and mobility (ERM).

From hospital day 1, key modifiable elements—analgesia, sedation, ventilation, and mobility—were systematically optimised. Our patient remained invasively mechanically ventilated throughout the ECMO treatment and was converted to a tracheostomy on hospital day 42. A pharmacist-led sedation weaning plan provided patient comfort and alertness, facilitating ERM. On hospital day 29, the patient completed five sessions of passive and active lower limb supine cycling. Family engagement fostered a supportive environment, reinforcing the importance of Family and Humanism elements of the PICUStars framework. No adverse events occurred during the physiotherapy interventions. This patient was successfully decannulated on hospital day 44 and ambulated before ward transfer.

This case demonstrates the safety and feasibility of aECMO and ERM in critically ill children through a structured, multidisciplinary approach.