Valentina Luminita Obreja, DNP, AG/AC NP-BC, CCRN, PHN

Abstract:

Background: Early mobility and ambulation of the extracorporeal membrane oxygenation (ECMO) patients has shown to decrease mechanical ventilation time, delirium, Intensive Care Unit (ICU) length of stay, and improve physical functioning. However, few ECMO centers use a protocol to guide mobilization and ambulation practices. Objectives: To improve the current practice in ambulating ECMO patients by examining the feasibility of an evidence-based ambulation protocol (AAP4ECMO; Adult Ambulation Protocol for ECMO) compared to historic controls on patient safety, number of ambulation sessions, time standing, ambulation time, and distance. Methods: Implementation of the protocol in a 24 bed ICU to determine the feasibility and safety in ECMO patients ≥ 18 years of age and compared to an age and gender-matched historical control group who ambulated without the protocol. Demographic and clinical outcome data were collected prospectively in the protocol group and retrospective chart review for the control group (safety events, ambulation outcome measures). Results: From January to March 2021, 13 (28%) ECMO patients utilized the developed AAP4ECMO protocol compared to 35 (10% 2019; 15% 2020) historic controls who ambulated without the protocol. There were no statistical differences in all ambulation measures with minimal adverse events. Conclusion: The AAP4ECMO protocol is feasible and safe to use in V-A and V-V ECMO patients deemed ready for ambulation. Despite an increased number of ambulation sessions in the protocol group, further prospective evaluation of the protocol is needed in a larger sample to verify findings and patient outcomes.

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