In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation – United Kingdom ECMO Physiotherapy Network: A consensus agreement for best practice

Eden, Allaina; Purkiss, Claire; Cork, Gabriella; Baddeley, Adam; Morris, Kelly; Carey, Leah; Brown, Mike; McGarrigle, Laura; Kennedy, Samantha

doi:10.1177/1751143717705801

Cited by 34 publications

(63 citation statements)

References 32 publications

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“…What emerged was that the management of patients undergoing extracorpo-real lung support is a multidisciplinary matter involving several professions, including respiratory therapists, thoracic surgeons, physiotherapists, nurses, and intensivists. 20,25,26 The creation of an international registry in 1989 by the Extracorporeal Life Support Organization has contributed to collecting data from 75,000 ECMO patients, enhancing the knowledge of extracorporeal life support procedures. 27 Together with the Extracorporeal Life Support Organization, the International ECMO Network is contributing to developing best practices for the organization of ECMO procedures.…”

Section: Discussionmentioning

confidence: 99%

“…27 In addition, from the available data, it appears that the safety of patients receiving venovenous ECMO is the major concern for professionals involved in the physiotherapeutic intervention. 25,26,28 Last, there is another important aspect that needs to be underlined. The development of national networks of rehabilitative interest for ECMO patients has provided indications for a multidisciplinary approach in such a particular class of patients.…”

Section: Discussionmentioning

confidence: 99%

“…This document has been recently released with the endorsement of the Association of Chartered Physiotherapists in Respiratory Care Committee. 26 It highlighted the importance of a multidisciplinary approach to ECMO patients, and, for the first time in the literature, described detailed procedures related to the rehabilitation treatment in such patients.…”

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

“…In addition, mobilization should be performed by at least 2 clinicians. 26 Thus, major indications for physiotherapy can be summarized by the following objectives: prevention of bed-related complications, improvement of functional ability and mood restoration, optimization of an early recovery, and improvement of clearance of secretions, and pulmonary ventilation. 26 Whereas an increasing number of experiences have been published regarding rehabilitation and ECMO support, less evidence has been found on physiotherapeutic treatment in patients receiving extracorporeal CO 2 removal.…”

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

“…26 Thus, major indications for physiotherapy can be summarized by the following objectives: prevention of bed-related complications, improvement of functional ability and mood restoration, optimization of an early recovery, and improvement of clearance of secretions, and pulmonary ventilation. 26 Whereas an increasing number of experiences have been published regarding rehabilitation and ECMO support, less evidence has been found on physiotherapeutic treatment in patients receiving extracorporeal CO 2 removal. In a pilot study, active daily rehabilitation was provided in 5 subjects with COPD who underwent CO 2 removal to facilitate extubation by using upper-body venous configuration via a dual lumen cannula with the goal of daily ambulation while in the ICU.…”

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

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Extracorporeal Lung Support for Hypercapnic Ventilatory Failure

et al. 2018

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Extracorporeal lung support can be achieved using extracorporeal membrane oxygenation (ECMO) and extracorporeal CO removal. The ECMO systems allow a total lung support, providing both blood oxygenation and CO removal. Unlike ECMO, extracorporeal CO removal refers to an extracorporeal circuit that provides a partial lung support and selectively extracts CO from blood. The concept of partial extracorporeal lung support by removing only CO without effect on oxygenation was first proposed in 1977 by Kolobow and Gattinoni, with the aim to reduce breathing frequency, ventilator tidal volumes, and inspiratory pressures, facilitating lung-protective ventilation. Patients with end-stage chronic lung disease can survive, while waiting for lung transplantation, only if treated with mechanical ventilation or extracorporeal lung support. ECMO has been considered a suitable approach as a bridge to lung transplantation for patients with advanced respiratory failure waiting for lung transplantation. Extracorporeal CO removal has been proposed for the treatment of COPD patients suffering from exacerbation to avoid invasive mechanical ventilation. The rationale is to combine the improvement of alveolar ventilation by using noninvasive ventilation with muscle unload provided by removing CO directly from the blood, using an extracorporeal device. Increasing attention has been given to the possibility of patients performing a variety of physical activities while receiving extracorporeal lung support. This is possible thanks to the continuous development of technology together with the customization of sedative protocols. Awake extracorporeal support is a specific approach in which the patient is awake and potentially cooperative while receiving ECMO. The present analysis aims to synthesize the main results obtained by using extracorporeal circuits in patients with respiratory failure, particularly in those patients with hypercapnia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

Section: Rehabilitation While Receiving Extracorporeal Lung Supportmentioning

confidence: 99%

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Extracorporeal Lung Support for Hypercapnic Ventilatory Failure

et al. 2018

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Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

Dresen

Naidoo²,

Hill

et al. 2022

J Parenter Enteral Nutr

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Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease‐associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, patients receiving ECMO are at increased risk for iatrogenic malnutrition and require targeted individual medical nutrition therapy (MNT). However, specific recommendations for MNT in patients receiving ECMO are limited and, with some exceptions, based on an evidence base encompassing general patients who are critically ill. Consequently, clinician decision‐making for MNT in patients receiving ECMO is unguided, which may further increase nutrition risk, culminating in iatrogenic malnutrition and ultimately affecting patient outcomes. The purpose of this article is to provide educational background and highlight specific points for MNT in adult patients receiving ECMO, which might serve as evidence‐based guidance to develop institutional standard operating procedures and nutrition protocols for daily clinical practice.

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