LAUSR

Dear Editor, The use of extracorporeal membrane oxygenation (ECMO) has expanded globally and is associated with prolonged bed rest, weakness and poor functional recovery [1]. Evidence is needed of safety and effectiveness of rehabilitation or early mobilisation while patients are on ECMO because of concerns related to catheter dislodgement, bleeding and cardio-respiratory instability [2, 3]. The aim of this randomised controlled pilot study was to determine if early mobilisation during ECMO was safe, feasible and to test functional outcomes in survivors compared to standard care. This was a randomised controlled trial of early goaldirected physiotherapy in critically ill patients during ECMO compared to standard care. It was conducted in three intensive care units (ICUs) of tertiary hospitals that are major ECMO centres in Australia. Ethical approval was obtained at Monash University and trial sites. Written prospective consent was sought from each patient or from a legal surrogate prior to enrolment. Patients received either early mobilisation within 72 h of ECMO commencement for 7 days or standard care (Methods, online supplement). The primary outcome was feasibility of delivering the intervention in the first 7 days after randomisation including separation between the groups for both the highest level of activity and duration of activity. Secondary outcomes included safety events, strength and function, ICU and hospital length of stay and mortality. Twenty patients were randomised in three ECMO centres (mean age 50 ± 15 years, 20% female) (Table E1, Figure E1). From 19 February 2018 to 20 May 2019, three sites recruited patients (as ethical approvals were obtained for each site). The average recruitment rate was 1.25 patients per month. One site randomised two patients per month, and two sites randomised one patient every 2 months. The early mobilisation intervention was feasible at three of four sites (75%) led by senior physiotherapists, while one site that originally planned to participate did not due to insufficient senior physiotherapy staff in ICU at the time. All patients randomised received the intervention according to the protocol (Online supplement) with either passive or active mobilisation. The intervention of early mobilisation increased the duration of mobilisation (median [IQR] 133 [82–220] vs. 27.5 [20.4–31] minutes) on days 1–7 compared to standard care but did not increase the median level of mobilisation (median ICU mobility scale 2.67 [0–5.3] vs. 1.5 [1–4.7]) (Fig. 1, Table E2). Active exercises occurred in four (40%) patients in the intervention group vs. one (10%) patient in the standard care group. There were two safety events reported for each group which ceased mobilisation and were resolved with no further consequences (online supplement, results). There were no differences for ICU and hospital length of stay and mortality (Online Supplement, Results, Table E3). In survivors, there was increased functional independence at hospital discharge in the early goal-directed physiotherapy group compared to standard care (Katz activities of daily living 6 [6–6] vs. 5 [4, 5]). *Correspondence: [email protected] Australia and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Level 3, 553 St Kilda Road, Melbourne, VIC 3004, Australia