Ann Rehabil Med.  2023 Jun;47(3):173-181. 10.5535/arm.22153.

Impact of Extra-Corporeal Membrane Oxygenation and Blood Purification Therapy on Early Mobilization in the Intensive Care Unit: Retrospective Cohort Study

• Watanabe S
• Iida Y
• Hirasawa J
• Naito Y
• Mizutani M
• Uemura A
• Nishimura S
• Suzuki K
• Morita Y

• KMID: 2543414
• DOI: http://doi.org/10.5535/arm.22153

Abstract

Objective
To investigate the effect on early mobilization in patients undergoing extra-corporeal membrane oxygenation (ECMO) and acute blood purification therapy in the intensive care unit (ICU).
Methods
We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU, aged ≥18 years, and received mechanical ventilation for >48 hours were eligible. The analyzed were divided into two groups: ECMO/blood purification or control group. Clinical outcomes; time to first mobilization, number of total ICU rehabilitations, mean and highest ICU mobility scale (IMS); and daily barrier changes were also investigated.
Results
A total of 204 patients were included in the analysis, 43 in the ECMO/blood purification group and 161 in the control group. In comparison of clinical outcome, the ECMO/blood purification group had a significantly longer time to first mobilization: ECMO/blood purification group 6 vs. control group 4 (p=0.003), higher number of total ICU rehabilitations: 6 vs. 5 (p=0.042), lower mean: 0 vs. 1 (p=0.043) and highest IMS: 2 vs. 3 (p=0.039) during ICU stay. Circulatory factor were most frequently described as barriers to early mobilization on days 1 (51%), 2 (47%), and 3 (26%). On days 4 to 7, the most frequently described barrier was consciousness factors (21%, 16%, 19%, and 21%, respectively)
Conclusion
The results of this study comparing the ECMO/blood purification group and the untreated group in the ICU showed that the ECMO/blood purification group had significantly longer days to mobilization and significantly lower mean and highest IMS.

Keyword

Early mobilization; Extra-corporeal membrane oxygenation; Acute blood purification therapy; Intensive care unit; Barrier

Figure

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  Fig. 1. Flow chart of the patient selection process. ICU, intensive care unit. a)Neurological complications include cerebral infarction, cerebral hemorrhage, acute subdual hematoma, acute epidural hematoma, traumatic subarachnoid hemorrhage, and encephalitis.

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  Fig. 2. Comparison of mean intensive care unit (ICU) mobility scale from day 1 to 7 of ICU admission. The one-way analysis of variance was used to compare the mean ICU mobility scale (IMS) from ICU admission to day 7 in the extra-corporeal membrane oxygenation (ECMO)/blood purification group and the control group. Comparison of mean IMS from ICU admission to day 7 was significantly lower in the ECMO/blood purification group compared with the control group (p<0.001). Measured by IMS, 0=no activity; 1=exercises in bed; 2=passively moved to the chair; 3=sitting on the edge of the bed; 4=standing; 5=transferring from bed to chair through standing; 6=marching on the spot; 7=walking with assistance of two people; 8=walking with assistance of one person; 9=walking independence with assistive device; and 10=walking independently.

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  Fig. 3. Algorithm to determine the primary barrier preventing mobilization. The barrier to mobilization was determined by the intensivist in charge of the patient following this algorithm. In every rehabilitation session, only one selected barrier was recorded in the medical record. SpO2, oxygen saturation of the peripheral artery; FiO2, fraction of inspiratory oxygen; PEEP, positive end-expiratory pressure; RASS, Richmond agitation sedation scale; BPS, behavioral pain scale; NRS, numerical rating scale.

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