Pediatric patients on veno-arterial extracorporeal membrane oxygenation undergoing cardiac rehabilitation have better outcomes

Abstract

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.

Keywords

• ECMO
• pediatric
• physical rehabilitation
• outcomes