(826) Protocolized Mobilization for Pediatric Venovenous ECMO Patients in an Academic Pediatric ICU

Introduction: Early mobility has been shown to be beneficial in pediatric intensive care unit (PICU) patients1. Children on extracorporeal membrane oxygenation (ECMO) support are some of the most critically ill patients and may benefit from early mobility. While there are descriptions of successful early mobility events in this population, most reports are either small case series of teenagers or part of unit wide ICU liberation programs and not focused on the needs of the pediatric ECMO patient2-5. This project aimed to demonstrate the safety and feasibility of implementing an ECMO-specific early mobilization protocol.

Methods: This project included PICU patients requiring ECMO between November 2022 - July 2024. A protocolized approach to early mobilization of ECMO patients was created to augment existing protocols. Inclusion criteria included patients ≥ 3 years old, venovenous ECMO, and cannulation with a bicaval double lumen cannula through the internal jugular vein. The protocol included multidisciplinary participation in bedside rounds to discuss daily mobility goals and timing, discussion of neuromuscular blockade holiday or sedative adjustment to facilitate optimal wakefulness for sessions, and completion of formal pre/post mobility checklists.

Results: Six patients met all inclusion criteria for protocol participation. All patients received physical & occupational therapy services while on ECMO. Four of the six patients were able to achieve a Richmond Agitation Sedation Scale (RASS) between -3 and 0 and participated in active exercise in bed. Of these four patients, one was able to mobilize into upright sitting, including static and dynamic seated exercise. The remaining two patients were unable to be liberated from neuromuscular blockade until after ECMO decannulation, thus received only passive interventions. These patients were also identified as having the shortest duration of ECMO support out of the current cohort. No adverse safety events were identified during or immediately after physical or occupational therapy sessions for any of the six patients.

Conclusions: We describe an early mobility protocol targeted specifically at pediatric VV ECMO patients. This protocol was safe and feasible in our small cohort. These results provide a framework for mobilization of children requiring ECMO.