Program Code: SCF-DBI-PECMO-RECOVERY-0009**
Operational Window: ECMO Stabilization → Active Recovery → Decannulation → ICU Recovery → Hospital Recovery → Longitudinal Reintegration
Primary Objective: Preserve functional capacity, accelerate recovery, prevent ICU-acquired disability, optimize neurodevelopmental outcomes, restore family resilience, and maximize long-term adaptive recovery.
SECTION 9.1
CLINICAL POSITIONING
Traditional ECMO Recovery Model
Recovery often begins:
After decannulation
After extubation
After ICU discharge
SCF-DBI Recovery Model
Recovery begins:
At cannulation
and progresses continuously through:
ECMO support
ICU recovery
Hospital recovery
Community reintegration
Core Principle
Every day without structured recovery intervention increases long-term disability risk.
SECTION 9.2
RHENOVA RECOVERY ACCELERATION ARCHITECTURE
Strategic Goal
Transform survival into functional recovery.
Recovery Domains
Domain 1
Neurologic Recovery
Domain 2
Cardiopulmonary Recovery
Domain 3
Musculoskeletal Recovery
Domain 4
Immune Recovery
Domain 5
Developmental Recovery
Domain 6
Family Recovery
Primary Output
Comprehensive Recovery Intelligence Score (CRIS)
SECTION 9.3
ECMO RECOVERY STAGING SYSTEM
Stage I
Recovery Preservation
Timeframe:
Cannulation → Stabilization
Objectives:
Prevent deterioration
Preserve reserve
Stage II
Recovery Activation
Timeframe:
Stable ECMO support
Objectives:
Initiate rehabilitation
Initiate developmental support
Stage III
Recovery Advancement
Timeframe:
Pre-decannulation
Objectives:
Functional restoration
Strength preservation
Stage IV
Recovery Reintegration
Timeframe:
Post-decannulation
Objectives:
Independence restoration
Long-term adaptation
SECTION 9.4
EARLY MOBILITY DURING ECMO FRAMEWORK
Clinical Positioning
Immobility is viewed as:
Progressive Recovery Failure Syndrome
Strategic Objectives
Preserve muscle mass
Preserve mobility
Preserve neurodevelopment
Preserve pulmonary recovery
Mobility Classification
Level 0
Passive Motion
Level 1
Positioning Optimization
Level 2
Bed-Based Activities
Level 3
Sitting Activities
Level 4
Standing Activities
Level 5
Ambulation During ECMO
when clinically appropriate
SECTION 9.5
ECMO MOBILITY READINESS ASSESSMENT
Cardiovascular Domain
Evaluate:
Hemodynamic stability
Flow stability
Oxygen delivery
Respiratory Domain
Evaluate:
Oxygenation
Ventilator stability
Neurologic Domain
Evaluate:
Consciousness
Cooperation
Safety
Cannulation Domain
Evaluate:
Cannula stability
Access security
Primary Output
Mobility Readiness Score (MRS)
SECTION 9.6
PHYSICAL MEDICINE & REHABILITATION INTEGRATION PLATFORM
Strategic Objective
Integrate rehabilitation into daily ECMO care.
Core Components
Physical therapy
Occupational therapy
Speech therapy
Developmental therapy
Neurorehabilitation
Daily Goals
Functional progression
Mobility progression
Recovery progression
Primary Output
Functional Recovery Index (FRI)
SECTION 9.7
DEVELOPMENTAL RECOVERY PRESERVATION PROGRAM
Applicable Populations
Neonates
Infants
Children
Adolescents
Strategic Objectives
Preserve cognitive development
Preserve language acquisition
Preserve psychosocial adaptation
Preserve educational potential
Monitoring Domains
Cognitive milestones
Language milestones
Social milestones
Behavioral adaptation
Primary Output
Developmental Recovery Index (DRI)
SECTION 9.8
ECMO-ASSOCIATED WEAKNESS PREVENTION PROGRAM
Clinical Positioning
Critical illness may cause:
Muscle wasting
Neuromuscular weakness
Functional impairment
Prevention Domains
Mobility
Nutrition
Sleep preservation
Sedation optimization
Rehabilitation
Monitoring Variables
Strength
Functional status
Mobility progression
FRI
SECTION 9.9
FAMILY RECOVERY INTELLIGENCE SYSTEM
Clinical Positioning
Family adaptation strongly influences patient recovery.
Domains
Education
Emotional resilience
Decision-making capacity
Caregiver preparedness
Monitoring Variables
Family engagement
Caregiver readiness
Psychosocial adaptation
Primary Output
Family Recovery Resilience Score (FRRS)
SECTION 9.10
RECOVERY INTELLIGENCE COMMAND CENTER
Strategic Objective
Coordinate all recovery operations.
Operational Domains
Neurologic recovery
Functional recovery
Developmental recovery
Immune recovery
Family recovery
Dashboard Outputs
CRIS
FRI
DRI
FRRS
MRS
SECTION 9.11
POST-DECANNULATION RECOVERY PATHWAY
Phase I
Physiologic Stabilization
Objectives:
Organ recovery
Endothelial recovery
Immune recovery
Phase II
Functional Restoration
Objectives:
Mobility recovery
Strength recovery
Endurance recovery
Phase III
Community Reintegration
Objectives:
Educational participation
Social participation
Family reintegration
SECTION 9.12
LONGITUDINAL RECOVERY SURVEILLANCE
Monitoring Timeline
Decannulation
↓
ICU Discharge
↓
Hospital Discharge
↓
30 Days
↓
90 Days
↓
6 Months
↓
12 Months
↓
Annual Surveillance
Recovery Domains
Physical function
Neurodevelopment
Growth
Educational adaptation
Quality of life
SECTION 9.13
DAILY RECOVERY INTELLIGENCE ROUNDS
Required Participants
ECMO Intensivist
Rehabilitation Medicine
Physical Therapy
Occupational Therapy
Speech Therapy
Nutrition
Nursing Leadership
Family Representative
Daily Review
CRIS
FRI
DRI
MRS
FRRS
Recovery trajectory
SECTION 9.14
RECOVERY ESCALATION MATRIX
Level 1
Enhanced Recovery Surveillance
Triggers:
Delayed mobility progression
Reduced rehabilitation participation
Level 2
Focused Recovery Intervention
Triggers:
CRIS decline >10%
FRI decline >10%
Level 3
Multidisciplinary Recovery Escalation
Triggers:
DRI decline >15%
Significant weakness progression
Family adaptation concerns
Level 4
Advanced Recovery Preservation Activation
Triggers:
CRIS <50
Functional deterioration
Recovery stagnation
Level 5
Recovery Rescue Pathway
Triggers:
CRIS <40
Severe disability trajectory
Long-term dependence risk
SECTION 9.15
RECOVERY SUCCESS ENDPOINTS
Clinical
Reduced ICU-acquired weakness
Reduced rehabilitation delays
Reduced long-term disability
Functional
Improved mobility
Improved independence
Improved participation in daily activities
Developmental
Preserved cognitive progression
Preserved educational participation
Preserved psychosocial adaptation
Biological Intelligence
CRIS >80
FRI >80
DRI >80
FRRS >80
MRS >80
Sustained adaptive recovery
PAGE 9 COMPLETION
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