Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2025; 17(8): 107811
Published online Aug 26, 2025. doi: 10.4330/wjc.v17.i8.107811
Early mobilization in patients on venoarterial extracorporeal membrane oxygenation: A scoping review
Vasiliki Kanellou, Konstantinos Kaliarntas, Despoina Myrto Dounavi, Irini Patsaki, Dimitrios Kalpaxis, Christos Kourek, Stavros Dimopoulos
Vasiliki Kanellou, Department of Physiotherapy, General Hospital of Nikea, Nikea 18450, Attikí, Greece
Konstantinos Kaliarntas, Department of Physiotherapy, School of Health Rehabilitation Sciences, University of Patras, Patra 26334, Dytikí Elláda, Greece
Konstantinos Kaliarntas, School of Applied Sciences, Edinburgh Napier University, Edinburgh EH11 4BN, United Kingdom
Despoina Myrto Dounavi, Department of Physiotherapy, Asklipeio Voulas Hospital, Voula 16673, Attikí, Greece
Despoina Myrto Dounavi, School of Health Science, Queen Margaret University, Edinburgh EH21 6UU, United Kingdom
Irini Patsaki, Department of Physiotherapy, University of West Attika, Aigaleo 12243, Attikí, Greece
Dimitrios Kalpaxis, Department of Physiotherapy, Central Clinic, Athens 10680, Attikí, Greece
Christos Kourek, Department of Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, The First Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 10676, Attikí, Greece
Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Attikí, Greece
Co-first authors: Vasiliki Kanellou and Konstantinos Kaliarntas.
Author contributions: Kanellou V performed the literature searches and screening and drafted the manuscript; Kaliarntas K performed the 2nd screening of the identified studies; Kanellou V and Kaliarntas K played important and indispensable roles in study design, data interpretation and manuscript preparation as co-first authors; Dounavi DM completed the appraisal of the evidence; Patsaki I, Kalpaxis D and Kourek C revised the draft; Dimopoulos S designed the study, made the final draft revision and approval; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors declare no conflict of interest in publishing the manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, MD, PhD, Consultant Physician-Scientist, Chief Director, Senior Researcher, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Avenue, Athens 17674, Attikí, Greece. stdimop@gmail.com
Received: March 31, 2025
Revised: May 7, 2025
Accepted: July 10, 2025
Published online: August 26, 2025
Processing time: 145 Days and 13.6 Hours
Abstract
BACKGROUND

Extracorporeal membrane oxygenation (ECMO) is mainly applied to patients with significant cardiorespiratory failure who do not respond to existing conventional treatments. Patients that are supported with veno-arterial ECMO (VA-ECMO) are considered very-high risk patients to participate in any type of physical therapy (PT) or mobilization. However, cumulative evidence suggests that early mobilization of critically ill patients is feasible, safe, and efficient under certain circumstances.

AIM

To summarize the existing evidence on the impact of early mobilization and physiotherapy on VA-ECMO patients.

METHODS

This is a scoping review that used systematic electronic literature searches (from inception until January 2025) on MEDLINE (PubMed), PEDro, DynaMed, CINAHL, Scopus, Science direct and Hellenic Academic Libraries. Snowball searching method was also applied. Eligible studies included those reporting patients on VA-ECMO who participated in early mobilization or PT, published in English and utilized any primary evidence study design. Studies on children, animals and patients placed on any other ECMO, secondary evidence, and ‘grey’ literature were excluded.

RESULTS

A total of 316 articles were retrieved and 13 were included in the study. Of those, 1 study was a randomized control trial, 4 retrospective studies, 4 retrospective cohort studies, 1 case series and 3 case reports. The sample size of the included studies ranged from 1 to 104 VA-ECMO patients, who were ambulated or received PT interventions, and mobilization frequency ranged from 2 per day to 4 per week. Mobilization of VA-ECMO patients seems to be safe regardless the cannula’s position. PT and early mobilization were associated with better weaning from mechanical ventilation, gradual reduction of inotropes and functional capacity improvement after ECMO discharge.

CONCLUSION

Early mobilization in VA-ECMO seems to be safe and can potentially help reduce vasoconstrictors and speed up rehabilitation times. High quality research on early mobilization in VA-ECMO patients is warranted.

Keywords: Physical therapy; Early ambulation; Extracorporeal membrane oxygenation; Physiotherapy; Early mobilization

Core Tip: This scoping review summarizes evidence of the effects of early mobilization on extracorporeal membrane oxygenation (ECMO) and veno-arterial ECMO (VA-ECMO) patients. VA-ECMO patients can safely participate in early mobilization and physical therapy (PT) interventions under certain criteria. Mobilization of VA-ECMO patients can be considered safe regardless of the anatomical insertion of the cannula. Mobilization and application of PT in VA-ECMO patients seems to contribute to improved respiratory volume and respiratory rate, as well as to the stabilization or reduction of inotropes. Specific PT and early mobilization intervention guidelines for VA-ECMO patients need to be developed.