Feasibility of Early Mobility During Pediatric Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort Study, 2018–2024

OBJECTIVES: To describe the feasibility of a progressive early mobility (EM) protocol in PICU patients requiring support with extracorporeal membrane oxygenation (ECMO). DESIGN: Single-center retrospective analysis of data from the 6-year period post-implementation of an EM protocol. SETTING: Medical-surgical PICU within a standalone academic children's hospital in the United States. PATIENTS: All PICU patients 0-18 years old supported on ECMO post-implementation of a unit-wide EM protocol (from June 2018 to July 2024). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-two patients met inclusion criteria. Overall, 52 of 62 patients (84%) underwent EM while on ECMO, with 18 of 52 patients (35%) undergoing EM achieving at least level II or III activity. Of 23 long-duration ECMO patients (i.e., requiring ECMO for ≥ 10 d), 14 of 23 patients achieved level II or III activity. Of 297 unique EM sessions, signs of intolerance occurred in 18 of 297 sessions (6.1% [95% CI, 3.9-9.4%]); these occurred in ten of 52 unique patients (19.2% [95% CI, 10.8-31.9%). There were no serious adverse events attributable to EM (0/297; upper limit of the 95% CI, 1.0%). However, an EM session in one patient was followed by recognition of neurologic changes on examination and a new diagnosis of stroke. CONCLUSIONS: Over 6 years in our PICU (2018-2024), we found that implementation of a progressive multidisciplinary EM protocol during ECMO was feasible. Our data also provide local metrics for rate of mobilization and level of activity achieved, signs of intolerance, and serious adverse events.