ArticleJHLT open2024
Pediatric patients on veno-arterial extracorporeal membrane oxygenation undergoing cardiac rehabilitation have better outcomes.
Article in JHLT open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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17 authors.
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Abstract
Background: The importance of physical rehabilitation in optimizing outcomes in critically ill patients is recognized. However, the frequency and benefit of mobilization in pediatric patients undergoing veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) are unclear. This study evaluates a cohort of pediatric VA-ECMO patients to characterize the spectrum of mobility and evaluate associations of mobilization with clinical outcomes. Methods: We analyzed 688 patients (8-18 years) who underwent primary ECMO runs and had mobilization data collected in the Extracorporeal Life Support Organization Registry. Demographics, pre-ECMO support, location and duration of support, and outcomes, including survival to hospital discharge, heart transplant, and ECMO-related complications, were collected. Propensity score modeling was performed with entropy weighting to compare outcomes between mobile and nonmobile patients. Results: Of the 688 patients included, 10% achieved some degree of mobility (69/688); the majority of those exercised in bed. After propensity score matching, mobility was associated with an increased likelihood of being discharged alive (odds ratio (OR) 1.16, 95% cardiac index (CI) 1.04, 1.30) and receiving a heart transplant (OR 1.15, 95% CI 1.02, 1.29), and a lower likelihood of dying on ECMO (OR 0.90, 95% CI 0.81, 1.00). There was no association between mobility and ECMO being discontinued due to complication (OR 1.03, 95% CI 0.97, 1.10). Conclusion: Mobilization in a pediatric VA-ECMO cohort was achieved by 1/10 patients, is associated with heart transplant and survival to hospital discharge, and is not associated with ECMO-related adverse events. Mobility in certain pediatric VA-ECMO patients is feasible and may represent an opportunity to improve outcomes.
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