Early Post-ECMO Mobilization Protocol (Passive/Active ROM, Sitting, Standing, Ambulation) Versus Standard Care on ICU Length of Stay, Muscle Strength, and Functional Independence at ICU Discharge: A Randomized Controlled Trial in Adult ECMO Patients

Abstract

Background: Adult survivors of extracorporeal membrane oxygenation (ECMO) are at high risk of ICU-acquired weakness, delayed mobility recovery, functional dependence, and prolonged ICU stay after decannulation. Objective: To determine whether a structured early post-ECMO mobilization protocol improved ICU length of stay, muscle strength, mobility, and functional independence compared with standard care in adult ECMO survivors. Methods: This prospective, single-center, parallel-group randomized controlled trial enrolled 80 adult ECMO survivors who were allocated equally to early mobilization or standard ICU care. The intervention included progressive passive and active range-of-motion exercises, sitting, standing, transfer training, and assisted ambulation under multidisciplinary monitoring. The primary outcome was ICU length of stay after ECMO decannulation. Secondary outcomes included Medical Research Council sum score, ICU Mobility Scale, Barthel Index, ICU-acquired weakness, adherence, and adverse events. Final complete-case analysis included 72 participants. Results: The intervention group had shorter ICU stay after decannulation than controls (5.8 ± 1.9 vs 7.4 ± 2.2 days; mean difference −1.6 days; 95% CI −2.57 to −0.63; p = 0.002). MRC sum score (50.8 ± 4.6 vs 46.2 ± 5.1; p < 0.001), ICU Mobility Scale score (median 7 vs 5; p < 0.001), and Barthel Index (63.4 ± 10.8 vs 54.1 ± 11.6; p = 0.001) were higher in the intervention group. ICU-acquired weakness was less frequent with early mobilization (22.2% vs 47.2%; p = 0.02). No major mobilization-related adverse events occurred. Conclusion: Structured early post-ECMO mobilization improved short-term ICU recovery without major safety concerns in stable adult ECMO survivors.