198 S . Pervaiz Butt et al .: J Extra Corpor Technol 2024 , 56 , 191 – 202
Figure 3 . Illustration of major ECMO complications .
candidates [ 49 , 55 – 57 ], albeit lacking detailed descriptions of physical therapy interventions .
Subsequent efforts to establish the safety and feasibility of awake and ambulatory ECMO in larger retrospective cohorts were successful , with low rates of adverse events [ 50 , 58 ] and minimal impact on physiologic parameters even in intensive rehabilitation intervention groups [ 59 ]. Study inclusions have widened to incorporate patients with femoral cannulation sites , also with positive safety profiles [ 51 , 60 ].
Recent evidence demonstrates the potential impact of awake and ambulatory ECMO – including improved function , clinical outcomes , and survival [ 61 – 64 ]. Patients cannulated for transplantation are observed to achieve earlier and greater mobility compared to non-transplant patients [ 60 , 64 ]. Reduced total hospital costs and post-transplant ICU costs of an ambulatory cohort supported on ECMO further promotes this as an economically superior management strategy [ 65 ]. However , high-quality investigations into exercise training protocols and elucidating short- and long-term effects remain essential [ 66 , 67 ].
ECMO complications
During LTx , the use of ECMO can provide vital support to the patient ’ s heart and lungs . However , this technique is not without potential complications . Some of the risks associated with ECMO in LTx include bleeding , infection , hemolysis , organ dysfunction , thromboembolism , cannula-related complications , neurological issues , barotrauma , and challenges specific to veno-arterial ECMO . These complications can arise from factors such as anticoagulation , cannula insertion , stress on other organs , and the mechanical forces within the ECMO circuit . Achieving hemostasis when bleeding occurs ( which can occur ~ 10 – 30 % of patients on ECMO ), particularly with hemoptysis , can prove particularly problematic and occasionally persists even when anticoagulation is withdrawn . The