Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: A practical approach*

Abstract

A comprehensive, multidisciplinary system can be developed to safely allow for active rehabilitation, physical therapy, and ambulation of patients being managed with extracorporeal membrane oxygenation. Such programs may lead to a decreased threshold for the utilization of extracorporeal membrane oxygenation before transplant and have the potential to improve conditioning, decrease resource utilization, and lead to better outcomes in patients who require extracorporeal membrane oxygenation before lung transplantation.

Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation

“…10 Several centers use ambulatory ECMO to rehabilitate patients to mitigate deconditioning in an attempt to improve outcomes in these critically ill patients. [11][12][13][14][15] Early studies demonstrated feasibility and potentially improved outcomes with this ECMO rehabilitation strategy as a bridge to transplantation. 14,16,17 In a single-center study, subjects who were spontaneously breathing while supported with ECMO had better 1-y survival rates post-transplant than did their mechanically ventilated counterparts who were supported with ECMO and proceeded to lung transplantation.…”

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

“…Although it is impossible to refute this approach outright, more recent analyses of data sets with propensity score matching indicate that survival for children on ECMO at the time of transplant may not be significantly different than those who do not require ECMO. Moreover, the earlier literature characterized by poor outcomes predates the development of centrifugal pumps, miniaturized ECMO circuits, and general movement from venoarterial to VV ECMO configurations which are all potentially associated with fewer ECMO related complications (1,3,5,7). NCH offers ECMO as bridge to transplant for local patients, most of whom have cystic fibrosis, when critical illness occurs in previously-listed patients.…”

“…With the advent of pediatric transplant and the development of more reliable longerterm support devices (such as miniaturized ECMO circuits, centrifugal pumps, and ventricular assist devices) the prior resistance to use ECMO to support irreversible organ failure is increasingly being reconsidered. Use of ECMO to bridge patients to lung transplantation is increasingly being done at transplant centers (1)(2)(3)(4)(5)(6)(7). For these reasons, pediatric ECMO centers are finding themselves supporting patients with irreversible heart and/or lung failure for whom organ transplantation is a potentially life-saving intervention.…”

Early Mobilization in the Intensive Care Unit

“…Perhaps most illustrative of the safety of early mobilization, a case series by Turner et al [23] studied early mobilization as part of a rehabilitation program for patients requiring extracorporeal membrane oxygenation (ECMO) support as a bridge to lung transplantation. In the patients requiring ECMO in this series, they reported no adverse events and it has become commonplace at our own institution to aggressively mobilize patients who require mechanical circulatory support.…”