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Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia

Received: 11 August 2025     Accepted: 26 August 2025     Published: 10 October 2025
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Abstract

Background: Extracorporeal Membrane Oxygenation (ECMO) represents an advanced life support technique employed in instances of severe cardiac or respiratory failure. Although ECMO significantly improves patient survival rates, extended stays in the intensive care unit (ICU) can result in complications such as ICU-acquired weakness and long-term functional disabilities. Early mobilization (EM) has emerged as a crucial intervention to mitigate these risks; however, its implementation among ECMO patients is often inconsistent, particularly within Saudi Arabia. Aim of the Study: This study aims to investigate the implementation of early mobilization (EM) guidelines for ECMO patients in a tertiary healthcare facility in Saudi Arabia. It seeks to identify key indications and contraindications for EM, assess barriers to its application, and develop as well as validate a standardized EM protocol for ECMO patients that can be utilized by healthcare providers across Saudi Arabia. Methods: Multidisciplinary approach was employed, involving clinical review assessments of patients’ readiness, indication, contraindications, safety protocols, guidelines, and monitoring parameters. The study analyzed existing EM practices, guidelines and the challenges faced by healthcare providers, particularly in the context of limited staffing, awareness and resources. Conclusion: The findings underscore the urgent need for standardized, evidence-based guidelines to facilitate the systematic implementation of EM in ECMO settings. By addressing safety considerations and promoting interdisciplinary teamwork, knowing the indications and contraindications, the study advocates for the integration of EM as a routine practice in the management of critically ill patients receiving ECMO. This approach aims to improve recovery trajectories and reduce the adverse effects associated with prolonged immobility in ICU environments, by using a standardize EM guidelines.

Published in Cardiology and Cardiovascular Research (Volume 9, Issue 4)
DOI 10.11648/j.ccr.20250904.12
Page(s) 120-130
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

ECMO, Early Mobilization, ICU, Guidelines, Veno-Venous, Veno-Arterial

References
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[2] Alshahrani, M. S., Faqihi, F., Balhamar, A., et al. (2021). Extracorporeal membrane oxygenation (ECMO) support for COVID-19 patients: A multi-center, prospective, observational study from Saudi Arabia. Frontiers in Medicine, 8, 727861.
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[4] Bartlett, R. H., Ogino, M. T., Brodie, D., et al. (2020). Initial ELSO guidance document: ECMO for COVID-19 patients with severe cardiopulmonary failure. ASAIO Journal, 66(5), 472-474.
[5] Alshahrani, M. S., Alghamdi, M. H., Alshehri, A. A., et al. (2016). ECMO support for Middle East respiratory syndrome coronavirus (MERS-CoV) patients in Saudi Arabia. Intensive Care Medicine, 42(4), 617-626.
[6] Needham, D. M., Korupolu, R., Zanni, J. M., et al. (2010). Early physical medicine and rehabilitation for patients with acute respiratory failure: A quality improvement project. Archives of Physical Medicine and Rehabilitation, 91(4), 536-542.
[7] Abrams, D., Javidfar, J., Farrand, E., Mongero, L., Agerstrand, C., Ryan, P.,... & Bacchetta, M. (2014). Early mobilization of patients receiving extracorporeal membrane oxygenation: A retrospective cohort study. Critical Care, 18(1), R38.
[8] Hodgson, C. L., Burrell, A. J., Engeler, D. M., et al. (2017). Early mobilization during extracorporeal membrane oxygenation was safe and feasible: A pilot randomized controlled trial. Critical Care, 21(1), 66.
[9] Al-Dorzi, H. M., Tamim, H. M., Al-Harbi, S. A., et al. (2016). Implementation of an intensive care unit clinical pharmacy service in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 36(5), 379-385.
[10] Al-Shehri, A., Al Harbi, M. M., Almutairi, M., et al. (2022). Early mobilization practices in intensive care units in Saudi Arabia: A national cross-sectional survey. Saudi Journal of Physical Therapy, 2(1), 23-30.
[11] Saudi Vision 2030. (2016). Kingdom of Saudi Arabia.
[12] Patel, B. K., et al. (2022). Mobilization of ECMO patients: Current evidence and safety considerations. Intensive Care Medicine, 48(1), 22-35.
[13] Hou, X., et al. (2020). Safety and benefits of early mobilization in patients on venovenous ECMO. Journal of Critical Care, 55, 128-134.
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[15] Hodgson, C., Needham, D., Haines, K., Bailey, M., Ward, A., Harrold, M., & Berney, S. (2014). Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart & Lung, 43(1), 19-24.
[16] Boyd, J., Paratz, J., Tronstad, O., Caruana, L., McCormack, P., & Walsh, J. (2018). When is it safe to exercise mechanically ventilated patients in the intensive care unit? An evaluation of consensus recommendations in a cardiothoracic setting. Heart & Lung, 47(1), 22-28.
[17] Rickelmann, C., & Knoblauch, D. J. (2018). Incorporating safe patient-handling techniques to mobilize our most complex patients on extracorporeal membrane oxygenation. Critical Care Nurse Quarterly, 41(3), 285-295.
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[21] Streiner, D. L., Hance, A., & Bakhru, R. N. (2021). The role of nurses in early mobilization in the ICU: A practical guide. Critical Care Nursing Clinics of North America, 33(3), 367-378.
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Cite This Article
  • APA Style

    Takroni, M., Hakami, U., Mirza, N., Ibhais, M. (2025). Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia. Cardiology and Cardiovascular Research, 9(4), 120-130. https://doi.org/10.11648/j.ccr.20250904.12

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    ACS Style

    Takroni, M.; Hakami, U.; Mirza, N.; Ibhais, M. Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia. Cardiol. Cardiovasc. Res. 2025, 9(4), 120-130. doi: 10.11648/j.ccr.20250904.12

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    AMA Style

    Takroni M, Hakami U, Mirza N, Ibhais M. Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia. Cardiol Cardiovasc Res. 2025;9(4):120-130. doi: 10.11648/j.ccr.20250904.12

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  • @article{10.11648/j.ccr.20250904.12,
      author = {Mohammed Takroni and Uthman Hakami and Nargis Mirza and Mohammed Ibhais},
      title = {Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia
    },
      journal = {Cardiology and Cardiovascular Research},
      volume = {9},
      number = {4},
      pages = {120-130},
      doi = {10.11648/j.ccr.20250904.12},
      url = {https://doi.org/10.11648/j.ccr.20250904.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20250904.12},
      abstract = {Background: Extracorporeal Membrane Oxygenation (ECMO) represents an advanced life support technique employed in instances of severe cardiac or respiratory failure. Although ECMO significantly improves patient survival rates, extended stays in the intensive care unit (ICU) can result in complications such as ICU-acquired weakness and long-term functional disabilities. Early mobilization (EM) has emerged as a crucial intervention to mitigate these risks; however, its implementation among ECMO patients is often inconsistent, particularly within Saudi Arabia. Aim of the Study: This study aims to investigate the implementation of early mobilization (EM) guidelines for ECMO patients in a tertiary healthcare facility in Saudi Arabia. It seeks to identify key indications and contraindications for EM, assess barriers to its application, and develop as well as validate a standardized EM protocol for ECMO patients that can be utilized by healthcare providers across Saudi Arabia. Methods: Multidisciplinary approach was employed, involving clinical review assessments of patients’ readiness, indication, contraindications, safety protocols, guidelines, and monitoring parameters. The study analyzed existing EM practices, guidelines and the challenges faced by healthcare providers, particularly in the context of limited staffing, awareness and resources. Conclusion: The findings underscore the urgent need for standardized, evidence-based guidelines to facilitate the systematic implementation of EM in ECMO settings. By addressing safety considerations and promoting interdisciplinary teamwork, knowing the indications and contraindications, the study advocates for the integration of EM as a routine practice in the management of critically ill patients receiving ECMO. This approach aims to improve recovery trajectories and reduce the adverse effects associated with prolonged immobility in ICU environments, by using a standardize EM guidelines.
    },
     year = {2025}
    }
    

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  • TY  - JOUR
    T1  - Implementation of Early Mobilization Protocols for ECMO Patients in the ICU: Clinical Review and Institutional Experience from a Tertiary Care Center in Saudi Arabia
    
    AU  - Mohammed Takroni
    AU  - Uthman Hakami
    AU  - Nargis Mirza
    AU  - Mohammed Ibhais
    Y1  - 2025/10/10
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    DO  - 10.11648/j.ccr.20250904.12
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    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
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    EP  - 130
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20250904.12
    AB  - Background: Extracorporeal Membrane Oxygenation (ECMO) represents an advanced life support technique employed in instances of severe cardiac or respiratory failure. Although ECMO significantly improves patient survival rates, extended stays in the intensive care unit (ICU) can result in complications such as ICU-acquired weakness and long-term functional disabilities. Early mobilization (EM) has emerged as a crucial intervention to mitigate these risks; however, its implementation among ECMO patients is often inconsistent, particularly within Saudi Arabia. Aim of the Study: This study aims to investigate the implementation of early mobilization (EM) guidelines for ECMO patients in a tertiary healthcare facility in Saudi Arabia. It seeks to identify key indications and contraindications for EM, assess barriers to its application, and develop as well as validate a standardized EM protocol for ECMO patients that can be utilized by healthcare providers across Saudi Arabia. Methods: Multidisciplinary approach was employed, involving clinical review assessments of patients’ readiness, indication, contraindications, safety protocols, guidelines, and monitoring parameters. The study analyzed existing EM practices, guidelines and the challenges faced by healthcare providers, particularly in the context of limited staffing, awareness and resources. Conclusion: The findings underscore the urgent need for standardized, evidence-based guidelines to facilitate the systematic implementation of EM in ECMO settings. By addressing safety considerations and promoting interdisciplinary teamwork, knowing the indications and contraindications, the study advocates for the integration of EM as a routine practice in the management of critically ill patients receiving ECMO. This approach aims to improve recovery trajectories and reduce the adverse effects associated with prolonged immobility in ICU environments, by using a standardize EM guidelines.
    
    VL  - 9
    IS  - 4
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