Critical Care |

Experience of Early Conditioning on Extracorporeal Membrane Oxygenation (ECMO) Therapy as Bridge to Transplantation or Recovery FREE TO VIEW

Pramod Guru, MD; Keith Bryant, RN; Tammy Friedrich, MSN; Jeffrey Riley, CCP; Dawit Haile, MD; Machael Nemergut, MD; Richard Daly, MD; Gregory Schears, MD
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Mayo Clinic, Rochester, MN

Chest. 2015;148(4_MeetingAbstracts):295A. doi:10.1378/chest.2225623
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Critical illness and immobility is considered a major determinant of morbidity and mortality associated with ECMO support for severe cardiorespiratory failure. Early conditioning of the ECMO patients with help of physical and occupational therapy has been shown to improve short term as well as long term outcomes.

METHODS: Retrospective analysis of patients bridged to transplantation with ECMO at a single tertiary care center with an active lung and heart transplantation program. We are reporting our experience of the ECMO patients who received multidisciplinary comprehensives active rehabilitation with aim for transplantation.

RESULTS: Between September 2012 and October 2014; eight patients were managed with active physical therapy (PT) during ECMO support. The median (IQR) age was 24 (8-51) years, and 5 (63 %) were female. Veno-arterial ECMO was used in five patients (63%) and veno-venous in three (37%). Avalon canula was used in three and others were managed by central cannulation. Cardiac decompensation due to cardiomyopathy was the primary reason for ECMO in four patients, and ARDS and pulmonary hypertension in others. The median (IQR) ECMO duration was 115 days (19-148). All but one patient were liberated from invasive mechanical ventilation while receiving ECMO. The median (IQR) first PT day was 13 (2-22) and the median (IQR) best PT day from the first was 43 (3-76). During PT sessions all patients (100%) were ambulated (five >100 yards) and only two were on vasopressor on the first PT day. ECMO circuit related complication observed in one patient and patient related complication in 63%. Five patients (63%) bridged to transplant (2 lungs, 2 heart and one combined), two died prior to transplant and one recovered. Of the five patients (63%) surviving to discharge, three discharged to acute rehabilitation and two went to home. The median (IQR) total ICU days were 129(27-210) and the post-transplant ICU days were 37(6-80).

CONCLUSIONS: Multidisciplinary approach for early conditioning in ECMO patients is safe and improves short term transplant outcomes. The impact of active rehabilitation during ECMO on transplant outcomes needs larger study.

CLINICAL IMPLICATIONS: Early mobilisation is feasible irrespective of the types of ECMO by which patients are supported for cardiorespiratory failure. Given the advancement in technology for safer practice, and increase use of ECMO in crtitically ill patients, it's worth to share the experience from established centers to achieve the goal for better patient care.

DISCLOSURE: The following authors have nothing to disclose: Pramod Guru, Keith Bryant, Tammy Friedrich, Jeffrey Riley, Dawit Haile, Machael Nemergut, Richard Daly, Gregory Schears

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