Development and application of a novel framework for mobility & rehabilitation under support of extracorporeal life support: The MUSECLS framework

IntroductionMobility and rehabilitation for patients supported on extracorporeal life support (ECLS) are high-risk and resource-intensive endeavors that currently lack a standardized framework to guide comprehensive program development. This paper introduces the framework to serve as a structured model that integrates best practice recommendations, relevant literature, and practical data from an ELSO Gold Level Center of Excellence program.MethodsInitially developed in response to the COVID-19 pandemic, the ECMO mobility program matured into a proactive and sustainable system through multidisciplinary collaboration, incorporation of current evidence, and iterative reflective practice. The resulting framework offers a structured, holistic approach to establishing effective ECLS mobility program.ResultsThe Mobility Under the Support of ECLS ("MUSECLS") framework comprised five interconnected domains, beginning with patient and family engagement and extending to institutional values and infrastructure. Implementation strategies and programmatic data from the originating ECMO center are used to illustrate practical application of the framework.ConclusionsThe MUSECLS framework provides a scalable and adaptable model to support the development or refinement of ECMO mobility and rehabilitation programs. It allows centers to tailor practices to local resources and populations while ensuring a comprehensive, evidence-informed approach. The framework is designed to remain applicable as clinical care and research in ECLS continue to advance.