(395) Impact of Physical Therapy Intensity on Functional Outcomes in Extracorporeal Membrane Oxygenation

Introduction: Physical therapy (PT) in patients supported with extracorporeal membrane oxygenation (ECMO) is important for preserving functional independence. The impact of PT intensity on ECMO recovery is not well understood. This study aimed to explore the relationship between PT intensity and functional outcomes in patients requiring ECMO.

Methods: This is a retrospective, single-center study of patients on ECMO for 3 or more days at a high-volume ECMO center during 2021. Patients were grouped by intensity of PT (high < 3 days, moderate 3-7 days, and low >7 days), calculated as the days from cannulation to discharge divided by PT sessions on or after ECMO. The primary outcome was the final Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Score. P-values given are for moderate vs. low intensity as there was no difference in high vs medium. For the subgroup of patients discharged alive, a multivariable logistic model was used to understand what affected a patient's odds of having a final AM-PAC score >18, indicating functional independence and safe home discharge.

Results: Of the 162 supported with ECMO, 142 met inclusion criteria (median age 48 years; 64% male). Patients received veno-arterial (n=64, 45%) or veno-venous (n=78, 55%) ECMO. Of the cohort, 61% (n=86) were discharged alive, 67% (n=95) had at least one PT session during their hospitalization, and 30% (n=43) had PT on ECMO. An AM-PAC score >18 was seen in 27% (n= 38) of patients. Patients were grouped by PT intensity: high (n=29, 20%), moderate (n=50, 35%), and low intensity (n=63, 44%). The high and moderate intensity groups were more likely to survive to discharge (76% and 74% vs. 43%, p=0.001) and discharge to home (38% and 42% vs. 17%, p=0.01). While controlling for age, sex, PT intensity, and the number of PT sessions after ECMO, modeling showed the number of PT sessions on ECMO (OR 1.10, 1.02-1.24), having an initial AM-PAC score >12 (OR 14.8, 2.9-191), total ICU days (OR 0.96, 0.91-0.99) and veno-arterial ECMO (OR 0.15, 0.02-0.79) significantly impacted the odds of a final AM-PAC score >18.

Conclusions: For patients supported with ECMO, high and moderate intensity PT as well as PT on ECMO were associated with improved functional outcomes. These findings support the implementation of PT to improve post-ECMO recovery.