Year: 2026 | Month: October | Volume: 13 | Issue: 10 | Pages: 123-133
DOI: https://doi.org/10.52403/ijrr.20261011
Early Mobilization and Respiratory Support for Patients on Extracorporeal Membrane Oxygenation (ECMO): A Scoping Review
Dr Srimonta Das PT1, Dr Rajendra Kachhwaha2, Dr Smruti Swagatika Dash3, Dr Deepak Jain4, Dr Bassety Praveen Kumar PT4
1Department Of Cardiovascular and Pulmonary Sciences, 2Department of Neurosciences, Department of CVPS, Department of Orthopaedic, Narayana Hrudayalaya Institute of Physiotherapy, Rajiv Gandhi University of Health Sciences, Bengaluru, India.
Corresponding Author: Dr Srimonta Das PT
ABSTRACT
Background: Extracorporeal membrane oxygenation (ECMO) provides life-sustaining support for patients suffering from severe, refractory acute respiratory distress syndrome (ARDS) or cardiogenic shock. Historically, clinical practice mandated deep neuromuscular blockade and continuous sedation to prevent adverse events such as cannula dislodgement, circuit disruption, and hemodynamic collapse. However, prolonged immobility precipitates rapid ICU-acquired weakness (ICUAW), diaphragmatic dysfunction, and secondary pulmonary complications. While early mobilization (EM) and active respiratory physiotherapy are increasingly integrated into critical care to counteract these adverse outcomes, their safety profiles, clinical feasibility, and operational protocols during ECMO remain variable and under defined.
Objective: To systematically map the existing clinical literature, establish standardized mobilization and respiratory physiotherapy protocols, evaluate safety profiles, and identify predefined termination criteria for physical rehabilitation in adult patients supported on ECMO.
Methods: A comprehensive scoping review was conducted adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A structured literature search across MEDLINE/PubMed, Embase, CINAHL, and the Cochrane Library identified primary clinical studies published between 2000 and 2025. Studies evaluating early physical mobilization, passive conditioning, active rehabilitation, or specialized respiratory physiotherapy during venovenous (VV) or venoarterial (VA) ECMO support were included.
Results: Synthesis of the literature demonstrates that progressive early mobilization and targeted respiratory physiotherapy—spanning from passive range-of-motion (PROM) and neuromuscular electrical stimulation (NMES) to standing, ergometry, and active ambulation—are feasible and clinically safe when executed by a dedicated, trained multidisciplinary team (MDT). Serious adverse events appear to be uncommon in published cohorts, although reported event rates vary across studies and definitions. Available evidence has generally demonstrated low rates of mobilization-related complications, but the heterogeneous reporting of adverse events prevents establishment of a universal incidence threshold. VV-ECMO cohorts demonstrate a significantly higher capacity for high-grade functional mobility (including ambulation) compared to VA-ECMO cohorts. VA-ECMO patients require conservative, lower-intensity modalities due to femoral arterial cannulation constraints, cardiac reserve limitations, and hemodynamic vulnerability. Most reported adverse events were minor, transient, and self-limiting (eg, brief desaturation, temporary postural hypotension, or minor line chattering).
Conclusion: Early mobilization and respiratory support during ECMO are feasible and safe, provided they are delivered within structured, multi-tiered safety protocols governed by an MDT. Current literature is primarily limited by observational methodology, heterogeneous reporting, and an absence of standardized safety outcome metrics. Future research must prioritize randomized controlled trials (RCTs) and evaluate long-term functional recovery, quality of life, and post-intensive care syndrome (PICS) outcomes.
Keywords: Extracorporeal membrane oxygenation (ECMO); Early mobilization; Respiratory physiotherapy; Critical care rehabilitation; ICU-acquired weakness; Awake ECMO; Patient safety.
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