ObjectiveAwake Extracorporeal Life Support (aECLS) with active mobilization has gained consensus over time, also within the pediatric community. This individual patient data (IPD) meta-analysis summarizes available evidence on pediatric aECLS, its feasibility, and safety regarding sedation weaning, extubation, and physiotherapy.MethodsPubMed/Medline and Cochrane Database were screened until February 2022. Articles reporting on children (≤18 years) undergoing aECLS were selected. IPD were requested, pooled in a single database, and analyzed using descriptive statistics. Primary outcome was survival to hospital discharge. Secondary outcomes included extubation during ECLS, physiotherapy performed, tracheostomy, and complications.ResultsNineteen articles and 65 patients (males: n = 30/59,50.8%) were included. Age ranged from 2 days to 17 years. ECLS configurations included veno-venous ( n = 42/65, 64.6%), veno-arterial ( n = 18/65, 27.7%) and other ECLS settings ( n = 5/65, 7.7%). Exclusive neck cannulation was performed in 51/65 (78.5%) patients. Extubation or tracheostomy during ECLS was reported in 66.2% ( n = 43/65) and 27.7% ( n = 18/65) of patients, respectively. Physiotherapy was reported as unspecified physical activity ( n = 34/63, 54%), mobilization in bed ( n = 15/63, 23.8%), ambulation ( n = 14/63, 22.2%). Complications were reported in 60.3% ( n = 35/58) of patients, including hemorrhagic (36.2%), mechanical (17.2%), or pulmonary (17.2%) issues, and need for reintubation (15.5%). Survival at discharge was 81.5% ( n = 53/65).ConclusionAwake ECLS strategy with active physiotherapy can be applied in children from neonatal age. Ambulation is also possible in selected cases. Complications related to such management were limited. Further studies on aECLS are needed to evaluate safety and efficacy of early physiotherapy and define patient selection.

中文翻译：

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清醒儿科体外生命支持的个体患者数据荟萃分析：镇痛、镇静和呼吸支持撤机以及物理治疗的可行性和安全性

目的 随着时间的推移，主动动员的清醒体外生命支持 (aECLS) 已获得共识，在儿科界也是如此。这项个体患者数据 (IPD) 荟萃分析总结了儿科 aECLS 的现有证据、其可行性以及有关撤除镇静、拔管和物理治疗的安全性。方法 PubMed/Medline 和 Cochrane 数据库筛选至 2022 年 2 月。报告儿童 (≤18 岁) 的文章年）进行 aECLS 被选中。请求 IPD，将其汇总到一个数据库中，并使用描述性统计进行分析。主要结局是存活至出院。次要结局包括 ECLS 期间拔管、进行的物理治疗、气管切开术和并发症。结果纳入 19 篇文章和 65 名患者（男性：n = 30/59,50.8%）。年龄从2天到17岁不等。 ECLS 配置包括静脉-静脉 (n = 42/65, 64.6%)、静脉-动脉 (n = 18/65, 27.7%) 和其他 ECLS 设置 (n = 5/65, 7.7%)。 51/65 (78.5%) 的患者进行了单纯颈部插管。 ECLS 期间拔管或气管切开术的患者比例分别为 66.2% ( n = 43/65) 和 27.7% ( n = 18/65)。物理治疗被报告为未明确的体力活动（n = 34/63，54%）、床上活动（n = 15/63，23.8%）、步行（n = 14/63，22.2%）。 60.3%（n = 35/58）的患者报告了并发症，包括出血（36.2%）、机械（17.2%）或肺部（17.2%）问题，以及需要重新插管（15.5%）。出院时存活率为 81.5% ( n = 53/65)。结论 清醒 ECLS 策略结合积极的物理治疗可应用于新生儿期的儿童。在某些情况下也可以步行。与这种管理相关的并发症是有限的。需要对 aECLS 进行进一步研究，以评估早期物理治疗的安全性和有效性并确定患者选择。