ID:172 FC-NP1-6 Safe mobilization of patients on VA-ECMO with transeptal LA drains.

Background: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an established therapy for refractory cardiogenic shock and cardiac arrest, providing temporary circulatory and respiratory support as a bridge to recovery, durable mechanical support, or transplantation. However, VA ECMO may increase left ventricular (LV) afterload, leading to LV distension and related complications. Left atrial (LA) decompression using a multifenestrated transseptal catheter can facilitate LV unloading and biatrial decompression. At our institution, the LA drain is positioned in the left upper pulmonary vein (LUPV) to optimize cannula stability given our aggressive mobilization culture. Although mobilization during VA ECMO is increasingly supported, evidence describing mobilization during left atrial veno-arterial ECMO (LAVA-ECMO) remains limited. Methods: We retrospectively reviewed 99 consecutive patients supported with LAVA-ECMO from 2020–2025 at a tertiary care center. Prior to April 2023, mobilization required tilt-bed verticalization to minimize risk of LA drain malposition. Following successful early mobilization in this cohort (n=8, 25 PT sessions), progressive mobility using traditional rehabilitation strategies was implemented while avoiding left-sided rolling (n=56, 232 PT sessions). Results: Overall survival to hospital discharge was 47.5% (47/99). 35.4% of patients were bridged to advanced surgical options (ASO), with 88.6% surviving to hospital discharge. Physical Therapy (PT) led mobilization occurred in 64.6% (64/99) of patients, with 26.6% (17/64) progressing to ambulation (ICU Mobility Score >8). Hemodynamic intolerance during mobilization occurred in 6.3% (4/64), requiring vasopressors (n=3) or amiodarone for unstable atrial fibrillation (n=1). No cannula migration or malposition occurred with either mobilization strategy. Conclusion: Mobilization during LAVA-ECMO appears safe and feasible within a coordinated multidisciplinary framework. Placement of the LA drain in the LUPV may provide additional cannula stability, supporting progressive rehabilitation without observed migration or malposition.