Authors (including presenting author) :
Tam OY, Kwan WS, Mak MY
Affiliation :
Physiotherapy Department, Tuen Mun Hospital
Introduction :
Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory support on respiratory and cardiac functions during acute critical disease, which has a remarkable progress in these two decades. Despite its remarkable result in providing life-saving mechanical circulatory support, there is high mortality and morbidity associated with ECMO. One of the major reasons of its complications is immobilization, which leads to a focus on early mobilization and physiotherapy during ECMO application.
Objectives :
The objective of this review is to determine the safety and feasibility of early mobilization for patients ECMO in the intensive care unit.
Methodology :
Five databases were used for systematic searching academic journals in this study. Articles published between January 2000 and May 2018 were included. The terms “Extracorporeal membrane oxygenation” and “Physiotherapy”, linked with the Boolean operator “AND” were used in searching of titles, abstracts and keywords. The inclusion criteria in this review are that subjects were put on ECMO applications and had received physiotherapy interventions included mobilization. Articles that did not address the physiotherapy interventions were excluded. Both qualitative and quantitative articles were included.
Result & Outcome :
A total of 79 citations were collected. Only 8 of the study had fulfilled the inclusion criteria. Four of them were retrospective cohort studies, four of them were case report or case series study. Two hundreds ad sixty nine subjects were included in these 8 studies. All of them showed the safety and feasibility of physiotherapy on ECMO. There is no prospective or randomized controlled trail evaluating the effect of physiotherapy during ECMO application. One retrospective study demonstrated significant lower intensive care unit stay and in-hospital mortality rate with receiving physiotherapy including chest physiotherapy and mobilization exercise. Conclusion This review has demonstrated the safety and feasibility of early mobilization for patients ECMO in the intensive care unit. Mobilization should be a treatment with high priority and should be started as soon as possible once the patients are stabilized in cardiovascular hemodynamic. Under the care of highly trained physiotherapists, rehabilitation program is safe and feasible. Larger prospective studies should be done to conclude the effectiveness and role of physiotherapy.
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