Cannulate, Extubate, Ambulate: Effect of a Mobility-Focused Program on Outcomes of COVID+ ECMO Patients at West Virginia University Medicine

ABSTRACT

Objective: The motto Cannulate, Extubate, Ambulate reflects the care ECMO patients receive at West Virginia University Medicine. Early mobility, crucial in our outcomes, especially with the COVID-19 population, is started with a Physical Therapist. This is followed by all team members participating in ECMO mobilization. This project examined the impact of mobilization for our COVID+ population placed on VV ECMO. Method(s) A WVU retrospective review was completed of COVID-19+ patients on ECMO between 3/2020 and 12/2021, determining survival to decannulation and discharge location. Mobility was examined for ECMOday of first active participation, first active transfer out of bed, and first ambulation. Further, PT sessions during cannulation, total PT, staff assist mobility while cannulated, and total number of sessions during admission. All patients who survived to discharge were included in survival rate, but those transferred to outside facilities for ECMO management were excluded from mobility and discharge location analyses. Result(s) Out of 91 patients, 70% successfully decannulated, and 98.4% survived to discharge. Mobilization began day 1 of ECMO, averaging 7.6 sessions/patient during their hospitalization. 88% performed their first active transfers with PT assist. Mobility sessions were also performed by Nursing/ECMO Specialists (3.6 times vs. 2.8 times). Total active mobilizations ranged 2-69 sessions, averaging 13.9 mobilizations during hospitalization. 60% of COVID-19 ECMO survivors were discharged home. Conclusion(s) Physical therapists lead mobility efforts, however, active involvement of nursing and ECMO Specialists is vital to provide continuity and repetition of mobility. Our results suggest teamwork improves patient survival and other important outcomes.