Utilization and determinants of rehabilitation in patients receiving extracorporeal membrane oxygenation in South Korea (2014-2018): A study based on Health Insurance Review and Assessment (HIRA) data.

Although the use of extracorporeal membrane oxygenation (ECMO) is increasing globally, survivors often face long-term physical and functional impairments. While recent clinical shifts toward "awake ECMO" highlight the importance of early rehabilitation, there is a significant gap between clinical evidence and real-world practice. This study used nationwide data to investigate the rates of rehabilitation utilization among ECMO patients in South Korea and identify the clinical and regional factors influencing access to rehabilitation. This retrospective cohort study focused on rehabilitation interventions from 2014 to 2018. Patients aged between 20 and 90 years who had received ECMO treatment, based on the Korean Health Insurance Review and Assessment database, were selected. Cases with hospital stays of <3 days were excluded. Patients admitted for respiratory illness were more likely to undergo rehabilitation than those admitted for circulatory disease (adjusted odds ratio [aOR]: 1.656, 95% confidence interval [CI]: 1.242-2.207). Patients who received ECMO for >4 days were more likely to receive rehabilitation (aOR for 5-9 days: 2.740, 95% CI: 2.094-3.587; aOR for ≥10 days: 2.987, 95% CI: 2.179-4.094). Patients on mechanical ventilation for >4 days were less likely to receive rehabilitation (aOR: 0.003, 95% CI: 0.002-0.005). Those with an intensive care unit length of stay exceeding 7 days were more likely to undergo rehabilitation (aOR: 7.787, 95% CI: 6.010-10.090). Regions with more hospitals offering cardiac rehabilitation programs, including cardiocerebrovascular centers, were positively associated with rehabilitation uptake. Rehabilitation in ECMO patients is influenced by clinical severity as well as structural and regional factors. Specifically, regional disparities in infrastructure and varying physician perceptions across specialties create inequalities in care access. Our findings underscore the need for standardized rehabilitation protocols and targeted policy interventions to harmonize clinical practices and optimize long-term functional recovery among ECMO survivors nationwide.