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When on ECMO: Awaken, Extubate and Mobilize

  • Rakesh C. Arora
  • Dave Nagpal
  • Yoan Lamarche
  • Rohan Sanjanwala
  • Andrea Szwajcer
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

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.

Keywords

VV ECMO VA ECMO Early mobilization Cardiothoracic surgery Post intensive care syndrome 

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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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Rakesh C. Arora
    • 1
    • 2
    • 3
  • Dave Nagpal
    • 4
  • Yoan Lamarche
    • 5
  • Rohan Sanjanwala
    • 2
  • Andrea Szwajcer
    • 6
    • 7
  1. 1.Department of Surgery, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
  2. 2.Cardiac Sciences ProgramSt. Boniface HospitalWinnipegCanada
  3. 3.I.H. Asper Clinical Research Institute – St. Boniface HospitalWinnipegCanada
  4. 4.Department of SurgerySchulich School of MedicineLondonCanada
  5. 5.Department of SurgeryMontreal Heart InstituteMontrealCanada
  6. 6.St. Boniface Hospital Research CentreWinnipegCanada
  7. 7.LibrariesUniversity of ManitobaWinnipegCanada

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