Nursing care of patients on ECMO in special clinical settings: Awake ECMO, early mobilization, and transport

ABSTRACT

Background: Extracorporeal membrane oxygenation (ECMO) is used in selected patients with severe respiratory or cardiac failure and requires complex, specialized care. Maintaining wakefulness, early mobilization, and transport during ongoing ECMO support create specific clinical, technical, and organizational requirements.

Aim: To investigate nursing care of adult patients receiving ECMO in three specific clinical settings: awake ECMO, early mobilization and ambulation, and transport and interhospital transfer during ongoing extracorporeal support.

Material and Methods: A literature review with descriptive and narrative synthesis was conducted. PubMed, Scopus, and CINAHL were searched for English-language publications from 2016 to 2025. Primary studies, case reports, reviews, and relevant guidelines were examined. Study design, clinical context, and the limitations of each publication were considered during the synthesis.

Results: The synthesis of the literature indicates that awake ECMO can be applied in selected patients, although its effect on clinical outcomes has not been adequately established. Early mobilization and ambulation can also be performed in appropriately selected patients, but their effectiveness and safety remain uncertain. Organized transport during ECMO is feasible, but it is not free of complications. Across all three settings, common requirements include continuous patient assessment, monitoring of the extracorporeal system, early recognition of complications, appropriate training, and interdisciplinary coordination.

Conclusions: Awake ECMO, early mobilization, and transport expand the possibilities of care for selected patients but are associated with increased safety requirements. The nursing role is central to patient assessment, monitoring, and coordination of care. The available evidence does not support considering these practices generally safer or more effective than alternative approaches.

Keywords: Extracorporeal mebrane oxygenation, Critical care nursing, Awake ECMO, early Ambulation, transportation