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PedsCrit
VV ECMO Part 4: Extubation, decannulation, and long-term effects
May 15, 2023
Guest Jenna Miller, MD, discusses the key milestones for extubation on VV-ECMO, mobilization practices for different age groups, and long-term neurologic effects. Also covered are the weaning and decannulation process, procedural sedation, and the importance of collaboration in VV-ECMO.
30:00
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Quick takeaways
- Early initiation of mobility and rehabilitation, including wakefulness and parental engagement, can enhance the recovery process and overall well-being of patients on ECMO.
- The decision to extubate or perform a tracheostomy in ECMO patients should be carefully considered based on factors such as the ability to manage secretions, lung condition, and airway protection.
Deep dives
Importance of Mobility and Rehabilitation for Patients on ECMO
Mobility and rehabilitation play a crucial role in the recovery process of patients on ECMO. Studies suggest that mobilizing patients in the ICU improves both their physical and psychological outcomes, leading to shorter hospital stays and improved overall condition. By promoting wakefulness, interaction with families, and avoiding global deconditioning, healthcare professionals aim to support the holistic healing of patients. Early initiation of mobility and rehabilitation is crucial, with sedatives and neuromuscular blockade being reduced or discontinued to allow patients to start moving within the first few days. Even neonates can benefit from mobility, focusing on wakefulness, oral stimulation, and holding by parents. Motor milestones for older children include sitting up, adjusting themselves in bed, playing games, and gradually progressing to standing and walking. Additionally, activities supporting mental health, such as engaging in virtual reality or art projects, can enhance the overall well-being of patients on ECMO.
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