Understanding implementation barriers to early mobilisation in patients receiving extracorporeal membrane oxygenation: A systematic approach

Abstract

Introduction: Patients requiring extracorporeal membrane oxygenation (ECMO) are the sickest patients in the hospital and commonly require prolonged bed rest. Early mobilisation is an intervention with strong potential to improve patient outcomes.

Objectives: The aim of this study was to investigate healthcare professionals' perceptions of the factors influencing the implementation of early mobilisation in patients receiving ECMO, within the context of the Early Rehabilitation in Patients on Extracorporeal Membrane Oxygenation (ECMO-Rehab) randomised controlled trial.

Methods: A qualitative study was conducted using purposive sampling to recruit healthcare professionals (physiotherapy and nursing) from the ECMO-Rehab trial sites. Participants were eligible if they had taken part in at least one ECMO-Rehab session involving trial-based mobilisation for patients receiving ECMO support. Semistructured telephone interviews were conducted between April 2023 and April 2024. Consolidated Framework for Implementation Research domains guided thematic mapping and analysis of responses.

Results: Semistructured interviews were conducted with 16 healthcare professionals (physiotherapy [n = 11] and nursing [n = 5]) from five hospital sites in Australia participating in the ECMO-Rehab randomised controlled trial. Eight major themes were identified across four domains and 15 constructs of the Consolidated Framework for Implementation Research. Major themes included perceived benefit from being involved in research and generating evidence; organisational networks facilitated collaboration and knowledge sharing; funding for staff and equipment; guidelines and training were pivotal in supporting safe implementation; interdisciplinary communications leading to effective implementation; leadership and teamwork to support implementation; culture within hospital setting creating positive experiences; and motivation and patient's needs.

Conclusions: This study found that the factors influencing implementation were multifaceted, complex, and closely inter-related. There is a need for coordinated efforts across the hospital systems, healthcare professionals, and with patients to achieve safe and effective early mobilisation practices in ECMO care. Future research should focus on the experience of patients receiving ECMO undergoing early mobilisation to further understand the special needs of these patients.

Keywords: Early mobilisation; Extracorporeal membrane oxygenation; Healthcare professionals; Intensive care; Physiotherapy; Qualitative research; Rehabilitation.