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When on ECMO: Awaken, Extubate and Mobilize

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Difficult Decisions in Cardiothoracic Critical Care Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Background: The use of extracorporeal membrane oxygenation (ECMO) has increased significantly to support cardio-respiratory failure patients. The ECMO utilization has worsened immobility for the critically ill patients.

Objective: To evaluate the evidence for the effects of early mobilization in cardiothoracic surgery patients receiving ECMO on feasibility and safety, duration of ECMO utilization as well as ICU and hospital length of stay.

Methods: Using a combination of MeSH terms: “early mobilization” and “ECMO”, Medline: Ovid, Embase, Scopus and CINAHL databases were searched. Studies were evaluated to determine fit to the inclusion criteria. Considering the limited amount of high quality evidence found, the inclusion criteria were expanded to include studies evaluating sedation interruption, extubation and early mobilization in intensive care unit patients with/without ECMO.

Results: Eighteen studies were selected. The quality of the selected studies was assessed using the GRADE system. All the included studies reported on a multidisciplinary team implementing early mobilization which was feasible and safe in patients receiving ECMO. One study reported on reducing the duration of ECMO, two studies reported reducing ICU and hospital length of stay and reducing ICU and hospital mortality among ECMO patients receiving early mobilization.

Conclusions: An experienced, multidisciplinary team undertaking early mobilization seems feasible and safe. Early mobilization is beneficial in reducing critical care associated complications as well as reduces ICU and hospital length of stay in patients receiving ECMO.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

ECMO:

Extracorporeal membrane oxygenation

E-CPR:

Extracorporeal membrane oxygenation (ECMO) assisted cardiopulmonary resuscitation

ICU:

Intensive care unit

PICS:

Post-intensive care syndrome

prICULOS:

Prolonged ICU length of stay

PTSD:

Post-traumatic stress disorder

SCCM:

Society of Critical Care Medicine

VA-ECMO:

Veno-arterial extracorporeal membrane oxygenation

VV-ECMO:

Veno-venous extracorporeal membrane oxygenation

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Author information

Authors and Affiliations

  1. Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada

    Rakesh C. Arora

  2. Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, MB, Canada

    Rakesh C. Arora & Rohan Sanjanwala

  3. I.H. Asper Clinical Research Institute – St. Boniface Hospital, Winnipeg, MB, Canada

    Rakesh C. Arora

  4. Department of Surgery, Schulich School of Medicine, London, ON, Canada

    Dave Nagpal

  5. Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada

    Yoan Lamarche

  6. St. Boniface Hospital Research Centre, Winnipeg, MB, Canada

    Andrea Szwajcer

  7. Libraries, University of Manitoba, Winnipeg, MB, Canada

    Andrea Szwajcer

Authors
  1. Rakesh C. Arora
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  2. Dave Nagpal
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  3. Yoan Lamarche
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  4. Rohan Sanjanwala
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  5. Andrea Szwajcer
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Editor information

Editors and Affiliations

  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

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Arora, R.C., Nagpal, D., Lamarche, Y., Sanjanwala, R., Szwajcer, A. (2019). When on ECMO: Awaken, Extubate and Mobilize. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_19

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  • DOI: https://doi.org/10.1007/978-3-030-04146-5_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04145-8

  • Online ISBN: 978-3-030-04146-5

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