30: Rates of Adverse Events Observed in Physical Therapy During ECMO are Similar Across Mobility Levels and Cannula Site

Introduction: Measures of adverse events and disability were established by international consensus to be among the most important outcomes for patients supported on ECMO.1 Physical therapy (PT) impacts the recovery trajectory for ECMO recipients and requires data to elucidate its safety profiles. This study reports the rates of adverse events with progressive mobility and femoral cannulation during PT sessions. Methods: Data analyzed from a single-center institutional PT-ECMO registry of all PT sessions from January, 2020 to October, 2024. Z-tests for sample proportions were used to compare event rates. Results: 802 PT sessions were delivered to 72 patients. Veno-venous ECMO accounted for 752 (93.8%) sessions and 57 (79.2%) patients. Femoral cannulation was present in 700 (87.3%) sessions. 271 (33.8%) sessions consisted of only supine exercises, 291 (52.5%) sessions achieved bedside mobility including sitting, standing, and marching, and 240 (29.9%) sessions were ambulatory. In total, 17 (2.1%) minor and 6 (0.7%) major events occurred (Table 1). Rates of minor events in bedside and ambulatory sessions (3.1% and 2.0%, respectively) were similar to supine sessions (1.1%; p=0.052 and 0.19, respectively). Rates of major events in bedside and ambulatory sessions (1.0% and 0.8%, respectively) were similar to supine sessions (0.4%; p=0.18 and 0.25, respectively). Rates of minor and major events (2.0% and 0.7%, respectively) in presence of femoral cannula were similar to rates of minor and major events (2.9% and 1.0%, respectively) with only jugular cannula (p=0.27 and 0.39, respectively). Conclusion: The literature commonly cites concerns regarding the safety of mobilizing patients on ECMO, particularly in presence of femoral cannula. These real risks were likely mitigated by implementing robust competencies, procedures, and standardized care – achieving event rates lower than often published. However, low rates of events may warrant advanced statistical approaches.