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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03328767
Registration number
NCT03328767
Ethics application status
Date submitted
24/10/2017
Date registered
1/11/2017
Titles & IDs
Public title
Extracorporeal Membrane Oxygenation Physical Training
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Scientific title
A Pilot Randomised Controlled Trial in Extracorporeal Membrane Oxygenation Physical Training (ECMO-PT)
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Secondary ID [1]
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ANZICRC/ECMO/001
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Universal Trial Number (UTN)
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Trial acronym
ECMO-PT
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Critically Ill, Mechanically Ventilated
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Extracorporeal Membrane Oxygenation Complication
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Condition category
Condition code
Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
BEHAVIORAL - Early activity and Mobilisation intervention
Experimental: Early activity and Mobilisation intervention - Patients will be randomised within 48 hrs of commencing ECMO. Patients unable to initially receive active physical training will receive passive physical training for a minimum of 20 minutes and a maximum of one hour per day to maintain joint and muscle activity until active physical training is commenced. The intervention involves a progression of exercises with the objective of rehabilitating the patient at the highest level of exercise possible for the patient for the longest period of time that can be tolerated (up to 60 minutes) at each session, based on our published ICU mobility scale now used internationally in ICU trials. This is performed with or without IMV (including both endotracheal tubes or tracheostomies).
No intervention: Standard Care - The control group will receive standard care from physiotherapy staff not involved in delivering the intervention. We have previously established that standard care in Australia for a patient receiving prolonged IMV (control group intervention) frequently involves no active exercise out of bed.
BEHAVIORAL: Early activity and Mobilisation intervention
The early activity and mobilisation intervention is comprised of exercises based on a reproducible, physiological approach using both strength and functional activities
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Intervention code [1]
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BEHAVIORAL
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Feasibility of delivering the intervention in the first 7 days after randomisation and the separation between the groups
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Assessment method [1]
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Feasibility of delivering the intervention in the first 7 days after randomisation and the separation between the groups using the ICU mobility scale to report the highest level of activity. It is reported as median (IQR) over 7 days.
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Timepoint [1]
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7 days
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Secondary outcome [1]
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Time to first stand out of bed
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Assessment method [1]
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Time to first stand out of bed (within the first 28 days)
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Timepoint [1]
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Within the first 28 days
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Secondary outcome [2]
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Incidence of Treatment-Emergent Adverse Events, Safety events (including decannulation of ventilator or ECMO cannula, fall to the floor during mobilization, desaturation SpO2 < 85%) at anytime during the first 7 days
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Assessment method [2]
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Incidence of Treatment-Emergent Adverse Events, Safety events (including decannulation of ventilator or ECMO cannula, fall to the floor during mobilization, desaturation SpO2 \< 85%) at anytime during the first 7 days
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Timepoint [2]
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During the first 7 days
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Secondary outcome [3]
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Strength at day 7 and 10
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Assessment method [3]
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Strength at day 7 and 10
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Timepoint [3]
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Days 7 & 10
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Secondary outcome [4]
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Function (reported as ICU mobility scale) measured at days 7, 10 and 20
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Assessment method [4]
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Function (reported as ICU mobility scale) measured at days 7, 10 and 20
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Timepoint [4]
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Days 7, 10 & 20
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Secondary outcome [5]
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ICU and hospital length of stay
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Assessment method [5]
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ICU and hospital length of stay (time from ICU admission to ICU and hospital discharge respectively censored at day 90)
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Timepoint [5]
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Time from ICU admission to ICU and hospital discharge respectively censored at day 90
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Secondary outcome [6]
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ICU and in-hospital mortality
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Assessment method [6]
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ICU and in-hospital mortality (time from ICU admission to ICU and hospital discharge respectively censored at day 90)
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Timepoint [6]
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Time from ICU admission to ICU and hospital discharge respectively censored at day 90
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Eligibility
Key inclusion criteria
* adults = 18 years of age
* were physically independent prior to the current admission;
* receiving ECMO (veno-arterial or veno-venous) for at least 24 hours;
* clinician in charge of patient care has no objection to randomisation
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Minimum age
18
Years
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Maximum age
80
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* have been in ICU > 5 days prior to the commencement of ECMO;
* have received ECMO for more than 48 hours;
* in the opinion of the treating clinician, is not expected to recover in 90 days (e.g. intracerebral haemorrhage);
* whom death is expected within 24 hours;
* are unable to communicate in English
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
19/02/2018
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/05/2020
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Sample size
Target
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Accrual to date
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Final
20
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC
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Recruitment hospital [1]
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Royal Prince Alfred Hospital - Camperdown
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Recruitment hospital [2]
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St Vincent's Hospital - Sydney
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Recruitment hospital [3]
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The Prince Charles Hospital - Chermside West
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Recruitment hospital [4]
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Alfred Hospital - Melbourne
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Recruitment postcode(s) [1]
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2050 - Camperdown
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Recruitment postcode(s) [2]
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2010 - Sydney
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Recruitment postcode(s) [3]
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4032 - Chermside West
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Recruitment postcode(s) [4]
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3004 - Melbourne
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Recruitment outside Australia
Country [1]
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Canada
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State/province [1]
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Ontario
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Funding & Sponsors
Primary sponsor type
Other
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Name
Australian and New Zealand Intensive Care Research Centre
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Address
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Country
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Other collaborator category [1]
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Other
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Name [1]
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Toronto General Hospital
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Address [1]
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Country [1]
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Other collaborator category [2]
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Other
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Name [2]
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Monash University
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Address [2]
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Other collaborator category [3]
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Other
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Name [3]
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The Alfred
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Address [3]
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Other collaborator category [4]
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Other
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Name [4]
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Royal Prince Alfred Hospital, Sydney, Australia
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Address [4]
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Country [4]
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Other collaborator category [5]
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Government body
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Name [5]
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The Prince Charles Hospital
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Address [5]
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Country [5]
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Other collaborator category [6]
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Other
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Name [6]
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St Vincent's Hospital, Sydney
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Address [6]
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Country [6]
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Ethics approval
Ethics application status
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Summary
Brief summary
Critically ill patients who require extracorporeal membrane oxygenation (ECMO) are the sickest in the hospital. More patients are surviving but survivors have compromised functional recovery for months or years. This trial aims to determine if early, physical training commenced within 48 hours of ECMO is feasible and improves muscle strength and functional status in patients compared to standard practice in a randomised controlled trial of 30 ICU patients.
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Trial website
https://clinicaltrials.gov/study/NCT03328767
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Trial related presentations / publications
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. doi: 10.1016/S0140-6736(09)60658-9. Epub 2009 May 14. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013 May;50(5):587-92. doi: 10.1016/j.ijnurstu.2012.09.010. Epub 2012 Nov 15. No abstract available. Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J, Buhr H, Higgins A, Presneill J, Berney S. Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung. 2014 Jan-Feb;43(1):19-24. doi: 10.1016/j.hrtlng.2013.11.003. Epub 2013 Nov 19. Erratum In: Heart Lung. 2014 Jul-Aug;43(4):388. Tipping CJ, Bailey MJ, Bellomo R, Berney S, Buhr H, Denehy L, Harrold M, Holland A, Higgins AM, Iwashyna TJ, Needham D, Presneill J, Saxena M, Skinner EH, Webb S, Young P, Zanni J, Hodgson CL. The ICU Mobility Scale Has Construct and Predictive Validity and Is Responsive. A Multicenter Observational Study. Ann Am Thorac Soc. 2016 Jun;13(6):887-93. doi: 10.1513/AnnalsATS.201510-717OC. Borg G. Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test. Int J Sports Med. 1982 Aug;3(3):153-8. doi: 10.1055/s-2008-1026080. Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther. 2012 Dec;92(12):1524-35. doi: 10.2522/ptj.20110406. Epub 2012 Aug 9. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, Bradley S, Berney S, Caruana LR, Elliott D, Green M, Haines K, Higgins AM, Kaukonen KM, Leditschke IA, Nickels MR, Paratz J, Patman S, Skinner EH, Young PJ, Zanni JM, Denehy L, Webb SA. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014 Dec 4;18(6):658. doi: 10.1186/s13054-014-0658-y. Puthucheary ZA, Denehy L. Exercise Interventions in Critical Illness Survivors: Understanding Inclusion and Stratification Criteria. Am J Respir Crit Care Med. 2015 Jun 15;191(12):1464-7. doi: 10.1164/rccm.201410-1907LE. No abstract available. ECMO-PT Study Investigators; International ECMO Network. Early mobilisation during extracorporeal membrane oxygenation was safe and feasible: a pilot randomised controlled trial. Intensive Care Med. 2020 May;46(5):1057-1059. doi: 10.1007/s00134-020-05994-8. Epub 2020 Mar 16. No abstract available.
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Public notes
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Contacts
Principal investigator
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Address
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Phone
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Fax
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Email
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Contact person for public queries
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Fax
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
Yes
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03328767