Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review

• Published in: Critical care explorations Vol. 6; no. 6; p. e1095
• Main Authors: Rivera, Julian D, Fox, Edward S, Fernando, Shannon M, Tran, Alexandre, Brodie, Daniel, Fan, Eddy, Fowles, Jo-Anne, Hodgson, Carol L, Tonna, Joseph E, Rochwerg, Bram
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-06-2024; Wolters Kluwer
• Subjects: Early Ambulation - methods; Extracorporeal Membrane Oxygenation - methods; Humans; Length of Stay; Physical Therapy Modalities; Systematic Review
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000001095

We planned to synthesize evidence examining the potential efficacy and safety of performing physical rehabilitation and/or mobilization (PR&M) in adult patients receiving extracorporeal life support (ECLS).
We included any study that compared PR&M to no PR&M or among different PR&M strategies in adult patients receiving any ECLS for any indication and any cannulation. We searched seven electronic databases with no language limitations.
Two reviewers, independently and in duplicate, screened all citations for eligibility. We used the Cochrane Risk of Bias 2 and Cochrane Risk Of Bias In Non-randomized Studies of Interventions tools to assess individual study risk of bias. Although we had planned for meta-analysis, this was not possible due to insufficient data, so we used narrative and tabular data summaries for presenting results. We assessed the overall certainty of the evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation framework.
We included 17 studies that enrolled 996 patients. Most studies examined venovenous extracorporeal membrane oxygenation (ECMO) and/or venoarterial ECMO as a bridge to recovery in the ICU. We found an uncertain effect of high-intensity/active PR&M on mortality, duration of mechanical ventilation, ICU length of stay, hospital length of stay, or quality of life compared with low-intensity/passive PR&M in patients receiving ECLS (very low certainty due to very serious imprecision). There was similarly an uncertain effect on safety events including clinically important bleeding, spontaneous intracerebral hemorrhage, limb ischemia, accidental decannulation, or ECLS circuit dysfunction (very low certainty due to very serious risk of bias and imprecision).
Based on the currently available summary of evidence, there is an uncertain effect of high-intensity/active PR&M on patient important outcomes or safety in patients receiving ECLS. Despite indirect data from other populations suggesting potential benefit of high-intensity PR&M in the ICU; further high-quality randomized trials evaluating the benefits and risks of physical therapy and/or mobilization in this population are needed.