A systematic review and meta-analysis of the timing of rehabilitation training intervention for recipients of extracorporeal membrane oxygenators

Introduction: The use of mechanical ventilation and sedatives in patients who undergo extracorporeal membrane oxygenation (ECMO) significantly increase the risk of disability. Rehabilitation training intervention (RTI) has the potential to enhance their cardiac function, exercise endurance, as well as overall hospitalization time and survival rate. However, the optimal timing of its initiation remains underexplored and lacks systematic evaluation.
Methods: A systematic review and meta-analysis were conducted to compare the effects of early and delayed RTI on recovery outcomes in patients undergo ECMO. Literature related to the timing of RTI during ECMO was retrieved from online databases including Embase, Pubmed, WOS, Science Direct, CNKI, VIP, and CBM. After screening and quality assessment, the effect sizes of rehabilitation outcomes were synthesized and evaluated.
Results: This study includes 5 randomized controlled trials, 4 non-randomized controlled trials, and 3 observational cohort studies. The meta-analysis results showed that the application of early RTI significantly reduced the risk of complications in ECMO patients compared to delayed RTI (Risk Ratio (RR)=0.43, 95% Confidence Interval (CI) [0.26; 0.69], Z=-3.48, P<0.001). Early RTI also shortened the stay time in ICU (Mean difference (MD)=-1.12, 95% CI [-1.30; -0.94], Z=-12.41, P<0.001), reduced hospitalization time (MD=-4.69, 95% CI [-8.11; -1.27], Z=-2.69, P=0.007), but did not significantly impact the mechanical ventilation time (MD=0.14, 95% CI [-2.48; 2.77], Z=0.11). P=0.914), ECMO duration (MD=-1.77, 95% CI [-4.10; 0.56], Z=-1.49, P=0.136), and in-hospital mortality (RR=0.72, 95% CI [0.49; 1.06], Z=-1.66, P=0.097).
Conclusion: Compared to delayed RTI, early RTI is associated with a reduced risk of complications and improved rehabilitation outcomes in ECMO patients. However, due to the relatively low level of evidence in this meta-analysis, further exploration is still needed on this topic.