Title: Physical Therapy and Sedation while on Extracorporeal Membrane Oxygenation for COVID-19 associated Acute Respiratory Distress Syndrome

Bohman, J. Kyle; Nei, Scott D.; Mellon, Laurie N.; Ashmun, R. Spencer; Guru, Pramod K.

OBJECTIVES: This study aimed to determine if patients on ECMO with COVID-19 achieved lower rates of physical therapy participation and required more sedation than those on ECMO without COVID-19. DESIGN: Retrospective observational matched cohort study. SETTING: Bicenter academic quaternary medical centers. PARTICIPANTS: All adults who underwent ECMO for severe COVID-19 associated ARDS during 2020 and matched (matched 1:1 based on age +/- 15 years and medical center) adults who underwent ECMO for non-COVID-19 ARDS. INTERVENTIONS: Observational only. MEASUREMENTS AND MAIN RESULTS: Measurements collected retrospectively during the first 20 days of ECMO support and included daily levels of physical therapy activity, number of daily sedation infusions and doses, and level of sedation and agitation (Richmond agitation and sedation score). During the first 20 day of ECMO support, the 22 patients who were on ECMO for COVID-19 associated ARDS achieved a similar proportion of days with active physical therapy participation while on ECMO compared to matched patients on ECMO for non-COVID-19 ARDS (22.5% vs 7.5%, respectively; p-value 0.43), a similar proportion of days with RASS ≥-2 while on ECMO (47.5% vs 27.5%, respectively; p-value 0.065), and a similar proportion of days with chemical paralysis while on ECMO (8.4% vs 18.0%, respectively; p-value 0.35). CONCLUSIONS: The results of this matched cohort study support that sedation requirements were not dramatically greater and did not significantly limit early physical therapy for VV-ECMO patients with COVID-19 associated ARDS compared to non-COVID-19 ARDS VV-ECMO patients.