Patrick Kelly, Adams Anthony
Kelly Patrick is a nurse and a cardiothoracic intensive care unit nurse educator, Tampa General Hospital, Tampa, Florida.
Anthony Adams is a nurse manager in the cardiothoracic intensive care unit, Anderson Hospital, Cincinnati, Ohio.
Crit Care Nurse. 2021 Aug 1;41(4):39-45. doi: 10.4037/ccn2021689.
Extracorporeal membrane oxygenation is increasingly used to provide cardiopulmonary support to patients awaiting lung transplant. Although studies have shown that these patients benefit from early mobilization, the care team often has concerns about related complications, particularly for patients requiring femoral cannulation.
To assess the safety of mobilizing patients receiving extracorporeal membrane oxygenation before lung transplant using a standardized mobility protocol.
A retrospective review was performed of the electronic health records of patients receiving extracorporeal membrane oxygenation before or immediately after lung transplant who were mobilized according to a standardized protocol from April through October 2018. The setting was an 18-bed cardiothoracic intensive care unit in a Magnet-designated teaching hospital. Patients were helped to ambulate by an interdisciplinary team, with careful assessment for any related complications.
During the study period, 37 patients received extracorporeal membrane oxygenation, and 9 were mobilized. Two hundred forty-two therapy sessions were conducted involving 47 700 feet of ambulation. Patients experienced the following complications: chugging (1 patient), decrease in flow rate (2 patients), bleeding at the cannula site (2 patients), neck hyperextension (1 patient), fear/anxiety (1 patient), and shortness of breath (2 patients). Bleeding and neck hyperextension led to discontinuation of therapy until the problems were resolved. No changes were made to the protocol.
Patients receiving extracorporeal membrane oxygenation before lung transplant, including those with femoral cannulation, can be mobilized safely with the use of an interprofessional ambulation protocol. Further evaluation is indicated, including research on clinical outcomes.
体外膜肺氧合越来越多地用于为等待肺移植的患者提供心肺支持。尽管研究表明这些患者从早期活动中获益，但护理团队通常担心相关并发症，尤其是对于需要股静脉插管的患者。
使用标准化的活动方案评估在肺移植前接受体外膜肺氧合的患者活动的安全性。
对2018年4月至10月期间根据标准化方案进行活动的肺移植前或肺移植后立即接受体外膜肺氧合的患者的电子健康记录进行回顾性分析。研究地点是一家获得磁铁认定的教学医院的18张床位的心胸重症监护病房。患者由跨学科团队协助进行走动，并仔细评估任何相关并发症。
在研究期间，37例患者接受了体外膜肺氧合，其中9例进行了活动。共进行了242次治疗，涉及47700英尺的走动。患者出现了以下并发症：呼吸急促（1例）、流速降低（2例）、插管部位出血（2例）、颈部过度伸展（1例）、恐惧/焦虑（1例）和呼吸急促（2例）。出血和颈部过度伸展导致治疗中断，直至问题解决。方案未作更改。
肺移植前接受体外膜肺氧合的患者，包括股静脉插管的患者，使用跨专业走动方案可以安全地进行活动。需要进一步评估，包括对临床结局的研究。
