Progressive Mobility of Patients Supported on ECMO from Dependency to Ambulation Utilizing Safe Patient Handling Technology

Extracorporeal membrane oxygenation (ECMO) is a mode of life support therapy for patients with serious respiratory and cardiovascular conditions when traditional therapy has failed. ECMO works by pulling the patient’s blood outside of the body via a centrifugal flow pump through an artificial cannula that serves as a vein that then passes through a hollow fiber oxygenator where oxygen is added and carbon dioxide is removed. The oxygenated blood is then returned back via an artificial cannula either to an artery or vein. The cannulas can be inserted in various sites such as the femoral artery/vein, the internal jugular vein, the axillary artery, or centrally inserted into the heart. These cannulas are held in place by external sutures and therefore can easily be dislodged or moved out of place. If either of these happens, this poses a fatal risk for exsanguination or suboptimal oxygen delivery. Until recently, these patients were sedated and did not engage in early mobility. However, recent research has shown the benefits of mobilizing these complex patients early helps to reduce ICU-acquired weakness, the complications associated with bed rest, and maximizes the postoperative functioning/recovery after lung or heart transplant. Mobilizing these complex patients requires a highly skilled and trained team to closely monitor the patient’s tubes, lines, cannulas, vital signs, etc. Patients with femoral cannulas can be more challenging to mobilize since precautions need to be taken to not excessively flex the hips to ensure proper securement of the cannulas. The priority when mobilizing patients supported on ECMO is largely placed on avoiding a patient adverse event, and not much attention is given to protecting the team members from injuries. Utilizing the patient lift equipment with this population can be challenging due to the multiple tubes, lines, and cannulas which can make sling placement difficult. This article will review how a level 1 trauma center was able to overcome the challenges associated with utilizing patient lift equipment with this population for turning, out-of-bed transfers, standing, and ambulation to maximize team member and patient safety. The use of the tilt bed technology can be especially helpful when mobilizing this population to ensure minimal movements of all the tubes, lines, and cannulas.

Labreche, M, Falk D, Kim OK, Patrick K, Simon B

Keywords: ICU, ECMO, safe patient mobility, caregiver safety