Abstract
Background and Purpose Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients.
Case Description This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues.
Outcomes In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients.
Discussion Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.
Footnotes
Dr Rahimi, Dr Reddy, Dr Zanni, Dr Stephens, and Dr Needham provided concept/idea/project design. Dr Rahimi, Ms Skrzat, Dr Reddy, and Dr Needham provided writing. Dr Rahimi, Ms Skrzat, and Dr Reddy provided data collection. Dr Rahimi, Ms Skrzat, Dr Fan, and Dr Needham provided data analysis. Dr Needham provided project management. Dr Fan, Dr Stephens, and Dr Needham provided patients. Dr Rahimi, Dr Zanni, Dr Fan, Dr Stephens, and Dr Needham provided consultation (including review of manuscript before submission).
An oral presentation of this case series was given at the Fifth International Meeting of Physical Medicine & Rehabilitation (PM&R) in the Critically Ill; May 19, 2011; San Francisco, California.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
- Received November 15, 2011.
- Accepted August 16, 2012.
