BACKGROUND: Early mobilisation (EM) within the first 72 h of ICU admission is essential for preventing ICU-acquired weakness; however, mobilisation rates remained low among mechanically ventilated (MV) COVID-19 patients during the pandemic waves. This study aimed to characterise the association between EM and 60-day outcomes. METHODS: A multicentre observational study conducted by the European Society of Intensive Care Medicine (ESICM) examined mobilisation strategies during the second COVID-19 wave (UNITE-COVIDed2021). All patients with confirmed SARS-COV-2 infection who were in the ICU on the peak day between 1st January and 1st June 2021 were included. The analysis expanded on the UNITE-COVIDed2020 study, comparing the first and second COVID-19 waves using a combined dataset. RESULTS: Data from 2053 patients during the second wave across 103 ICUs in 35 countries were analysed and compared with 4190 patients from the first wave. EM was achieved in 801 (39%) vs. 1114 (27%), p < 0.001, respectively. In the combined cohort, MV on admission significantly reduced the likelihood of EM (OR 0.29, 95% CI: 0.25-0.33, p = 0.001). While EM did not improve ICU or hospital length of stay, it was associated with reduced 60-day mortality (OR 0.74, 95% CI: 0.64-0.86, p = 0.001) and transfer rates to other care facilities (OR 0.74, 95% CI: 0.59-0.94, p = 0.001). CONCLUSION: EM is feasible and beneficial for critically ill COVID-19 patients. It was associated with reduced mortality and lower transfer rates to other care facilities, which underscores the critical role of EM in enhancing patient recovery during a pandemic.

Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Anaesthesiology and Intensive Care Medicine Berlin Germany

Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Anaesthesiology and Intensive Care Medicine Berlin Germany; Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Radiology Berlin Germany

Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Department of Anaesthesiology and Intensive Care Medicine Berlin Germany; Medical University of Vienna Department of Anaesthesia Intensive Care Medicine and Pain Medicine Clinical Division of General Anaesthesia and Intensive Care Medicine Vienna Austria

Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin Institute of Biometry and Clinical Epidemiology Berlin Germany

Department of Anaesthesia and Intensive Care 3rd Faculty of Medicine Charles University Prague Czech Republic; FNKV University Hospital Prague Prague Czech Republic

Department of Biomedical Sciences Humanitas University Milan Italy; IRCCS Humanitas Research Hospital Milan Italy

Department of Critical Care Guy's and St Thomas' Hospital London United Kingdom

Department of Critical Care King's College Hospital London United Kingdom

Department of Intensive Care Medicine University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Department of Intensive Care Medicine VUmc Amsterdam The Netherlands

Department of Internal Medicine and Pediatrics Faculty of Medicine and Health Sciences Ghent University Ghent Belgium; Department of Hematology Ghent University Hospital Ghent Belgium

Department of Internal Medicine and Pediatrics Faculty of Medicine and Health Sciences Ghent University Ghent Belgium; Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium

Intensive Care Unit Department of Surgical Sciences Uppsala University Uppsala Sweden

Intensive Care Unit Hospital General Universitario de Castellón Castellón de la Plana Spain

Médecine Intensive et Réanimation APHP Saint Louis Hospital Paris University Paris France

School of Medicine and Surgery University of Milano Bicocca Milan Italy; Department of Neuroscience Neurointensive Care IRCCS Fondazione San Gerardo dei Tintori Monza Italy

School of Sports and Health Sciences University of Brighton Brighton United Kingdom

Service de Médecine Intensive Réanimation Hôpital Bicêtre AP HP Université Paris Saclay France

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