Physical Therapy Interventions in Critically Ill Patients Requiring Extra-Corporeal Membrane Oxygenation (ECMO)

Introduction: Physical therapy (PT) implemented early in the intensive care unit is purported to improve short] and longterm outcomes for critically ill patients requiring mechanical ventilation. Preliminary research suggest that PT may also be beneficial for a subset of critically ill patient requiring extra]corporal membrane oxygenation (ECMO). Purpose: The primary purpose of this study is to determine the relationship between the timing and frequency of PT interventions with patient outcomes of mortality, length]of]stay (LOS), and physical function in patients requiring ECMO. We hypothesis that patients with reduced times to initial PT session and a higher frequency while on ECMO will have reduced mortality, ICU LOS, and higher independence at hospital discharge. Methods: Retrospective analysis of adult patients requiring ECMO (n = 649) at an academic medical center from 2009] 2018. Main Outcomes and Statistical Analysis: The primary dependent outcome is mortality with secondary outcomes of ECMO days, ICU LOS, and hospital LOS. Independent rehabilitation variables of interest include time to first PT, frequency of PT, time to first day out of bed, and time to first day with ambulation. In addition, we will assess if rehabilitation data correlates with functional outcomes, activities of daily living, and independence at hospital discharge. A sub]analysis of patients participating in .3 sessions of PT on ECMO will be performed using a trajectory analysis to determine the responsiveness to physical therapy. Final logistic model will be conducted to predict mortality with demographics and clinical variables (such as severity of illness) as confounders. We will also stratify data by age, diagnosis, severity of illness, and sedation usage. If physical therapy interventions hospital and/or ICU LOS, a cost]effectiveness analysis will be performed. Conclusions: These data provide an avenue to analyze the timing and dosage of physical therapy approaches provided to patients on ECMO.