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

Turner, David A. MD; Cheifetz, Ira M. MD, FCCM; Rehder, Kyle J. MD; Williford, W. Lee RRT; Bonadonna, Desiree BSE, CCP, LP; Banuelos, Scott J. MD; Peterson-Carmichael, Stacey MD; Lin, Shu S. MD, PhD; Davis, R. Duane MD; Zaas, David MD

doi: 10.1097/CCM.0b013e3182282bbe
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Objective: Extracorporeal membrane oxygenation as a bridge to lung transplantation has traditionally been associated with substantial morbidity and mortality. A major contributor to these complications may be weakness and overall deconditioning secondary to pretransplant critical illness and immobility. In an attempt to address this issue, we developed a collaborative program to allow for active rehabilitation and physical therapy for patients requiring life support with extracorporeal membrane oxygenation before lung transplantation.

Design: An interdisciplinary team responded to an acute need to develop a mechanism for active rehabilitation and physical therapy for patients awaiting lung transplantation while being managed with extracorporeal membrane oxygenation. We describe a series of three patients who benefited from this new approach.

Setting: A quaternary care pediatric intensive care unit in a children's hospital set within an 800-bed university academic hospital with an active lung transplantation program for adolescent and adult patients.

Patients, Interventions, and Main Results: Three patients (ages 16, 20, and 24 yrs) with end-stage respiratory failure were rehabilitated while on extracorporeal membrane oxygenation awaiting lung transplantation. These patients were involved in active rehabilitation and physical therapy and, ultimately, were ambulatory on extracorporeal membrane oxygenation before successful transplantation. Following lung transplantation, the patients were liberated from mechanical ventilation, weaned to room air, transitioned out of the intensive care unit, and ambulatory less than 1 wk posttransplant.

Conclusions: 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.

From the Division of Pediatric Critical Care Medicine (DAT, IMC, KJR, SPC), Department of Pediatrics, Duke Children's Hospital; Respiratory Care Services (IMC, LW), Perfusion Services (DB), Divisions of Cardiovascular and Thoracic Surgery (SSL, RDD) and Pulmonary, Allergy, and Critical Care Medicine (DZ), and Departments of Surgery (RDD, SSL), Immunology (SSL), and Pathology (SSL), Duke University Medical Center, Durham, NC; Department of Surgery (SJB), Norwood Hospital, Norwood, MA.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: david.turner@duke.edu

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins