Takahide Toyoda

Purpose Managing acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (V‐V ECMO), without sedation/neuromuscular blockade to allow physical and occupational therapy (PT/OT) participation, is untraditional. Here, we investigate the impact of early PT/OT initiation on discharge functional activity for ARDS patients managed on V‐V ECMO. Methods This is a retrospective review of 67 ARDS patients managed with V‐V ECMO at a single academic center from February 2018 to June 2021. Data collected included patient characteristics, days of V‐V ECMO support, day of PT/OT initiation, and ambulation distance and Activity Measure for Post‐Acute Care (AMPAC) Six‐Clicks score on day of discharge. Results Patients with >7 days of V‐V ECMO support had decreased ambulation and AMPAC scores compared to those with <7 days (70.5 vs. 162.1, p < 0.01 and 12.3 vs. 16.4, p = 0.01, respectively). PT/OT initiation within 7 days after starting V‐V ECMO significantly improved ambulation and AMPAC scores (163.5 vs. 59.5, p < 0.001, and 16.6 vs. 11.8, p < 0.01, respectively). Additionally, in patients with >7 days of V‐V ECMO support, those who began PT/OT within 8 days of V‐V ECMO cannulation had significantly improved ambulation and AMPAC scores (151.8 vs. 44.2, p < 0.01, and 16.5 vs. 11.0, p < 0.01, respectively). Conclusion Early PT/OT initiation in severe ARDS patients managed on V‐V ECMO is associated with improved patient functional activity on day of discharge. Our study further supports the use of V‐V ECMO in treatment of severe ARDS without sedation/neuromuscular blockade and specifically demonstrates PT/OT should be started early following V‐V ECMO cannulation.