Rehabilitation during extracorporeal membrane oxygenation: bridging the gap between life support and functional recovery.

Abstract

Rehabilitation during extracorporeal membrane oxygenation (ECMO) has become a promising intervention to mitigate the profound physical and functional decline that occurs with prolonged critical illness. With the wider adoption of ECMO, interest has grown in integrating early mobilization into routine care practices to preserve muscle mass, reduce intensive care unit-acquired weakness, and improve long-term patient outcomes. Emerging observational data indicate that structured rehabilitation protocols-including passive and active mobilization-are feasible and safe, including for individuals undergoing femoral cannulation. Nevertheless, multiple obstacles, including patient instability, technical constraints, staffing limitations, and gaps in clinical knowledge, impede broader implementation. Although the theoretical rationale and initial data are compelling, further robust randomized controlled trials are essential to establish the definitive efficacy, best-practice protocols, and cost-effectiveness of rehabilitation interventions in ECMO-supported patients.