Long-term physical disability in the sickest of the sick: Assessment of persons treated with Extracorporeal Membrane Oxygenation (ECMO) and early mobilization

Research Objectives: Since 2018, persons with severe respiratory failure at our institution (including during the COVID-19 pandemic) have been managed with extracorporeal membrane oxygenation (ECMO) and aggressive early mobilization. While survival rates to decannulation and hospital discharge have been impressive, the long-term physical disability is currently not well studied. As part of a new ECMO-survivorship program focused on identifying and addressing long-term sequalae of surviving extreme critical illness, we examined the physical mobility needs reported by persons who were discharged home.

Design: Single-cohort survey study

Setting: Academic medical center in rural Appalachia

Participants: All persons receiving ECMO from January 2018 through December 2021 who survived to discharge home were eligible for participation in a one-time survey of current physical disability.

Interventions: n/a

Main Outcome Measures: Survivors were contacted in person or via telephone to compete the Activity Measure for Post Acute Care (AM-PAC) outpatient mobility short form questionnaire. They rated their current level of difficulty in performing 18 tasks ranging from walking in the home to vigorous recreation. Frequency and cumulative disability ratings were calculated.

Results: 97 of 242 survivors (40%) completed the survey. Mean age was 44 yrs (range 21-74 yrs). Average duration of ECMO was 16 days (range 3-90 days). 85% received physical therapy while cannulated as part of the early mobilization program. Mean disability was 31% (SD = 20%, range 0-100%). 97% reported at least minimal difficulty with at least 1 item. Most difficult tasks involved vigorous or long-duration activities. Disability did not differ by indication for ECMO (COVID (44%) vs. other), age, or length of time from decannulation to survey.

Conclusions: Similar to other critical illness survivors, survivors of ECMO report physical disability, despite aggressive and customized early mobility interventions. These mobility limitations appear to be independent of length of time since decannulation, age or diagnosis, suggesting that disability is a common experience in survivors. Routine assessment and appropriate referral for physical rehabilitation is recommended to address these unmet mobility needs.

Author(s) Disclosures: none