Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

Abstract Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

摘要：科技进步与重症监护病房（intensive care units，ICU）多学科团队的协作，显著提升了重症患者的存活率。重症监护领域的核心生命支持手段为体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）。尽管针对重症患者的研究数量持续增长，但迄今为止鲜有研究证实物理治疗联合体外膜肺氧合支持的安全性与临床获益。
本综述通过检索MEDLINE®、物理治疗证据数据库（PEDro）、考克兰对照试验中心注册库（Cochrane CENTRAL）、LILACS及EMBASE数据库，并手动检索截至2017年9月发表的文献的参考文献列表，分析了接受体外膜肺氧合支持的成年患者接受物理治疗后的临床结局。数据库检索共获取1213项相关研究，最终纳入20项，涉及317名受试者，其中对照组58人。
12项研究报告称，物理治疗期间未出现相关并发症。两项研究报告了共3例不良事件：活动时套管断裂1例、回输套管血栓形成1例、下肢肿胀1例；另有两项研究报告了血氧饱和度下降与轻度眩晕。与之相对，接受物理治疗的患者在呼吸/肺功能、运动功能储备、肌肉力量（伴随肌肉量丢失减少）、肌病发生率、住院时长及全因死亡率方面均呈现改善。
对现有数据的分析表明，包括早期渐进性活动、站立、行走及呼吸训练在内的物理治疗方案，联合体外膜肺氧合支持，对于重症成年患者而言是可行的、相对安全的，且具有潜在临床获益。