Use of Structured Exercise Program with Resistance Training and Verticalization in Adults on Extracorporeal Membrane Oxygenation: A Prospective Pilot Study

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is crucial in the management of severe cardiopulmonary dysfunction. Although early rehabilitation in the ICU has been shown to reduce ICU-acquired weakness and improve patient outcomes, there is limited evidence on structured rehabilitation programs for patients on ECMO. OBJECTIVES: We evaluated the safety, feasibility, and preliminary effectiveness of a standardized daily program combining mobility therapy and resistance training during ECMO support. DESIGN: The primary outcome was time on exercise training per day. Task performance, repetitions in resistance exercises, adverse events, hospital disposition, and body mass index (BMI) changes were documented. SETTING: Prospective single-center pilot study. SUBJECTS: Subjects on ECMO ( n = 20, 47 ± 15 years old, 80% male, 95% venovenous ECMO). INTERVENTIONS: Subjects received a protocolized regimen: morning mobility with physical/occupational therapy (PT/OT) using a tilt/verticalization bed, activities of daily living, and graded transitions (sitting, standing, ambulation), followed by afternoon resistance exercises with a clinical exercise physiologist (≥ 5 d/wk). MEASUREMENTS AND MAIN RESULTS: Two minor adverse events occurred, which both resolved immediately. Day-28 survival was 95%, and in-hospital survival was 85%. Among survivors, 56% were discharged home, and 44% experienced an increase in BMI from admission to discharge. Daily therapy times averaged 21 minutes for PT/OT (median: 20), 30 minutes for resistance sessions (median: 27), and 35 minutes of combined daily exercise (median: 35, maximum: 122). Longer session times correlated with faster supine-to-sitting transitions in PT/OT ( p = 0.002). In resistance trainings, longer session times were associated with significantly increased repetitions in bicep and triceps flexion and extensions, chest press, shoulder press, and hip/knee flexion ( p < 0.001). CONCLUSIONS: A structured daily program that combines mobility, verticalization, and resistance exercises during ECMO was feasible and safe. More time in sessions was associated with better functional performance. Larger controlled studies are needed to determine effects on recovery and long-term outcomes.