Safety and Feasibility of Mobility on Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO): A Case Report

Purpose: Physical and occupational therapy for patients on transitional mechanical circulatory support (MCS) is critical to reduce deconditioning, promote recovery, and optimize candidacy for advanced therapies. Despite the growing evidence, there are still real and perceived barriers to mobilization of patients on MCS, particularly with those on less common extracorporeal membrane oxygenation (ECMO) configurations. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) involves cannulation inside the heart, which presents unique mobility-related risks. Consequently, many institutions exclude this population, as well as others with unique cannulation strategies, from mobility protocols by default. This can lead to missed opportunities to maintain or regain function during prolonged hospitalization. Methods: A patient with cardiogenic shock was cannulated for LAVA-ECMO. In coordination with the medical and multidisciplinary team, mobility was initiated with careful and intentional progression to ensure circuit integrity and assess patient tolerance throughout each session. Interventions began with use of the tilt table and upper extremity ergometer and progressed to activities of daily living training, transfer training, and ambulation. Results: There were no adverse events during mobility, as defined by hemodynamic instability that was unresponsive to medication titration, bleeding, or cannula displacement. The patient demonstrated gross motor progression as seen by an increase in the Activity Measure for Post-Acute Care Basic Mobility score from 11 to 17 during this time. Conclusion: Balancing safety and mobility in high-acuity populations remains a common challenge in critical care. In our case, we were able to demonstrate that mobility with a rare ECMO configuration is feasible and can be performed safely through extensive multidisciplinary planning and in accordance with current guidelines in literature. This example encourages a case-by-case model to assess appropriateness for mobility rather than a default exclusion based solely on high-acuity or a rare configuration. This will allow the opportunity for each patient to safely achieve their highest level of mobility within team-approved parameters.