Abstract:

Objective To develop and validate a risk-level assessment system for early mobilization in patients undergoing VV-ECMO to promote the safety and standardization of early mobilization. Methods Convenience sampling was employed to select VV-ECMO patients hospitalized in the ICU of a tertiary A hospital in Hangzhou from January 2024 to August 2025 as the study subjects. Patients admitted from November 2024 to August 2025 were designated as a trial group（n=27），who received early mobilization guided by a risk-level assessment system in addition to routine interventions. Patients admitted from January to October 2024 were designated as a control group（n=27），who received routine early mobilization care. After the intervention，the 2 groups were compared on the differences in the following parameters，including first active mobilization initiation time，early mobilization implementation rate，optimal activity level，incidence of ICU-acquired weakness，incidence of delirium，incidence of activity-related adverse events，duration of VV-ECMO support，duration of mechanical ventilation，and length of ICU stay. Results The trial group had 2 cases of dropout，with 25 cases ultimately enrolled；the control group had 3 cases of dropout，with 24 cases ultimately enrolled. After the intervention，the trial group demonstrated higher rates of early mobilization implementation and optimal activity levels compared to the control group（P<0.05）. The trial group also exhibited shorter first active mobilization initiation time，shorter VV-ECMO support duration，shorter mechanical ventilation duration，and lower incidence of ICU-acquired weakness（P<0.05）. No statistically significant differences were observed between the 2 groups in terms of delirium incidence or ICU length of stay（P>0.05）. No severe adverse events occurred during the activity sessions. Conclusion The risk-level assessment system can safely and effectively promote early mobilization in VV-ECMO patients. It provides clinicians with an intuitive and structured decision-support tool.

Key words: Veno-Venous Extracorporeal Membrane Oxygenation, Early Mobilization, Risk Assessment, Critical Care

摘要：

目的 构建并验证静脉-静脉体外膜肺氧合（veno-venous extracorporeal membrane oxygenation，VV-ECMO）患者早期活动风险等级评估系统，以促进ICU患者早期活动的安全与规范化实施。方法 采取便利抽样法，选取2024年1月—2025年8月在杭州市某三级甲等医院ICU住院的VV-ECMO患者作为研究对象，将2024年11月—2025年8月的患者设为试验组（n=27），在常规护理的基础上实施风险等级评估系统指导下的早期活动；将2024年1—10月的患者设为对照组（n=27），实施常规早期活动护理。干预后，比较两组VV-ECMO支持期间首次主动活动启动时间、早期活动实施率、最佳活动水平、ICU获得性衰弱发生率、谵妄发生率、活动相关不良事件发生率、VV-ECMO支持时间、机械通气时间、ICU住院时间的差异。结果 试验组脱落2例，最终纳入25例；对照组脱落3例，最终纳入24例。干预后，试验组早期活动实施率、最佳活动水平高于对照组（P<0.05）；试验组首次主动活动启动时间、VV-ECMO支持时间、机械通气时间及ICU获得性衰弱发生率均低于对照组（P<0.05）；两组谵妄发生率、ICU住院时间比较，差异无统计学意义（P>0.05）；活动过程中均未发生严重的不良事件。结论 应用该风险等级评估系统能够安全、有效地推动VV-ECMO患者早期活动，可为临床提供一种直观、结构化的决策支持工具。

关键词: 静脉-静脉体外膜肺氧合, 早期活动, 风险评估, 重症护理