A systematic review and meta-analysis of the timing of rehabilitation training intervention for recipients of extracorporeal membrane oxygenators

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• Picked for Critical Care and Intensive Care Medicine (paper of the day, 22 October 2026): Early rehabilitation outcomes among patients receiving ECMO

Abstract

OBJECTIVE: To systematically evaluate the effects of early versus delayed rehabilitation training interventions (RTI) on clinical outcomes in patients receiving extracorporeal membrane oxygenation (ECMO). METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), non-randomized controlled studies, and observational cohort studies comparing early and delayed RTI in patients receiving ECMO. We searched databases including Embase, PubMed, Web of Science, ScienceDirect, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc from inception to 1 April 2025. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Outcomes included complications, intensive care unit (ICU) and hospital length of stay (LOS), duration of mechanical ventilation, ECMO duration, and in-hospital mortality. RESULTS: Twelve studies (five RCTs, four non-RCTs, and three cohort studies) were included. Compared with delayed RTI, early RTI significantly reduced the risk of complications [risk ratio (RR) = 0.43, 95% CI: 0.26-0.69, P < 0.001], shortened ICU LOS [mean difference (MD) = -1.12 days, 95% CI: -1.30 to -0.94, P < 0.001], and reduced hospital LOS (MD = -4.69 days, 95% CI: -8.11 to -1.27, P = 0.007). No significant differences were found in mechanical ventilation duration (MD = 0.14 days, P = 0.914), ECMO duration (MD = -1.77 days, P = 0.136), or in-hospital mortality (RR = 0.72, P = 0.097). Sensitivity analysis excluding one study demonstrated a greater reduction in hospital LOS significant (MD = -5.82 days, 95% CI: -9.34 to -2.30, P = 0.001), while other outcomes remained unchanged. CONCLUSIONS: Early RTI is associated with reduced complications and improved recovery outcomes (ICU/hospital stay) in ECMO patients compared with delayed RTI. However, due to the limited number and moderate quality of included studies, these findings should be interpreted with caution. High-quality RCTs are needed to confirm these results. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251025533, PROSPERO CRD420251025533.

Abstract as published, via PubMed.