Pediatric patients on veno-arterial extracorporeal membrane oxygenation undergoing cardiac rehabilitation have better outcomes
J.B. Edelson,
L. Wooster,
J. Huang,
Z. Wang,
J. Connelly,
J. Rossano,
M. O’Connor,
C.D. Mavroudis,
J.R. Eichner,
J.W. Gaynor,
A.G. DeWitt,
S.H. Evans,
J. Edwards,
C.A. Wittlieb-Weber,
K.Y. Lin,
M. Lane-Fall,
K. Maeda
Affiliations
J.B. Edelson
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Corresponding author: J.B. Edelson, Division of Cardiology, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Suite 8NW90, Philadelphia, PA 19104.
L. Wooster
Department of General Pediatrics, the Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
J. Huang
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
Z. Wang
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
J. Connelly
ECMO Center, the Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
J. Rossano
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania
M. O’Connor
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
C.D. Mavroudis
Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
J.R. Eichner
Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
J.W. Gaynor
Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
A.G. DeWitt
Division of Cardiac Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
S.H. Evans
Division of Physical Medicine and Rehabilitation, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
J. Edwards
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
C.A. Wittlieb-Weber
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
K.Y. Lin
Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
M. Lane-Fall
Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
K. Maeda
Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Background: The importance of physical rehabilitation in optimizing outcomes in critically ill patients is recognized. However, the frequency and benefit of mobilization in pediatric patients undergoing veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) are unclear. This study evaluates a cohort of pediatric VA-ECMO patients to characterize the spectrum of mobility and evaluate associations of mobilization with clinical outcomes. Methods: We analyzed 688 patients (8-18 years) who underwent primary ECMO runs and had mobilization data collected in the Extracorporeal Life Support Organization Registry. Demographics, pre-ECMO support, location and duration of support, and outcomes, including survival to hospital discharge, heart transplant, and ECMO-related complications, were collected. Propensity score modeling was performed with entropy weighting to compare outcomes between mobile and nonmobile patients. Results: Of the 688 patients included, 10% achieved some degree of mobility (69/688); the majority of those exercised in bed. After propensity score matching, mobility was associated with an increased likelihood of being discharged alive (odds ratio (OR) 1.16, 95% cardiac index (CI) 1.04, 1.30) and receiving a heart transplant (OR 1.15, 95% CI 1.02, 1.29), and a lower likelihood of dying on ECMO (OR 0.90, 95% CI 0.81, 1.00). There was no association between mobility and ECMO being discontinued due to complication (OR 1.03, 95% CI 0.97, 1.10). Conclusion: Mobilization in a pediatric VA-ECMO cohort was achieved by 1/10 patients, is associated with heart transplant and survival to hospital discharge, and is not associated with ECMO-related adverse events. Mobility in certain pediatric VA-ECMO patients is feasible and may represent an opportunity to improve outcomes.
