Predictors of early mobilization in patients requiring VV ECMO for greater than 7 days: An international cohort study
Abstract
Background
Despite the demonstrated benefits of rehabilitation, active physical therapy and early mobilization are not universally performed during critical illness, especially among patients receiving extracorporeal membrane oxygenation (ECMO), with variation among sites.
Objective
What factors are predictive of physical mobility during venovenous (VV) ECMO support?
Methods
We performed an observational analysis of an international cohort using data from the Extracorporeal Life Support Organization (ELSO) Registry. We analyzed adults (≥18 years) supported with VV ECMO who survived for at least 7 days. Our primary outcome was early mobilization (ICU Mobility Scale score >0) at day 7 of ECMO support. Hierarchical multivariable logistic regression models were utilized to identify factors independently associated with early mobilization at day 7 of ECMO. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).
Results
Among 8,160 unique VV ECMO patients, factors independently associated with early mobilization included cannulation for transplantation (aOR 2.86 [95% CI 2.08–3.92]; p<0.001), avoidance of mechanical ventilation (aOR 0.51 [95% CI 0.41–0.64]; p<0.0001), higher center level patient volume (6–20 patients annually: aOR 1.49 [95% CI 1 to 2.23] and >20 patients annually: aOR 2 [95% CI: 1.37 to 2.93]; p<0.0001 for group), and cannulation with a dual-lumen cannula (aOR 1.25 [95% CI 1.08–1.42]; p = 0.0018). Early mobilization was associated with a lower probability of death (29 vs 48%; p<0.0001).
Conclusions
Higher levels of early mobilization on ECMO were associated modifiable and non-modifiable patient characteristics, including cannulation with a dual-lumen cannula, and with high center level patient volume.