Physiotherapeutic Guidelines for Initiating and Terminating Early Mobility for Patients on Extracorporeal Membrane Support

Background: Extracorporeal membrane oxygenation (ECMO) therapy is a crucial intervention for critically ill patients, but prolonged immobilization can lead to physical deconditioning and complications. Early progressive mobility (EPM) protocols aim to mitigate these challenges, yet uncertainties exist regarding the optimal timing and criteria for initiating and terminating physical therapy during ECMO support. Objective: This scoping review aims to synthesize existing literature to address key questions concerning physical therapy management during ECMO therapy, focusing on the physiological parameters guiding the initiation and termination of therapy sessions. Methods: A systematic search was conducted using PRISMA guidelines to identify relevant studies from January 2013 to October 2023. Eligibility criteria were established, and data extraction was performed to identify physiological parameters utilized in physical therapy decision-making for ECMO patients. Results: Thirteen studies, comprising various study designs and expert consensus documents, were included in the review. Physiological parameters such as hemodynamic stability, oxygenation, sedation scales, and specific thresholds emerged as crucial considerations for initiating and terminating physical therapy interventions. While some consensus exists, variability in criteria highlights the need for standardized guidelines. Conclusion: Despite the growing recognition of the importance of early mobility and physical therapy in ECMO patients, gaps in evidence remain regarding optimal management strategies. Formal protocols integrating detailed physiological parameters could enhance patient safety and optimize rehabilitation practices. Further research and consensus-building efforts are essential to establish definitive guidelines for physical therapy management during ECMO support, ultimately improving patient outcomes and enhancing the quality of care.