Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy.
Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University General Hospital, Nuremberg, Germany.
Artif Organs. 2022 Jan;46(1):30-39. doi: 10.1111/aor.14110. Epub 2021 Nov 14.
The coronavirus diseases 2019 (COVID-19) pandemic posed severe difficulties in managing critically ill patients in hospital care settings. Extracorporeal membrane oxygenation (ECMO) support has been proven to be lifesaving support during the SARS-CoV-2 outbreak. The purpose of this review was to describe the rehabilitative treatments provided to patients undergoing ECMO support during the COVID-19 pandemic.
We searched PubMed and Scopus for English-language studies published from the databases' inception until June 30, 2021. We excluded editorials, letters to the editor, and studies that did not describe rehabilitative procedures during ECMO support. We also excluded those articles not written in English.
A total of 50 articles were identified. We ultimately included nine studies, seven of which were case reports. Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients and a case series of three patients. Extracorporeal support duration varied from 9 to 49 days, and the primary indication was acute respiratory distress syndrome COVID-19-related. Rehabilitative treatment mainly consisted of in-bed mobilization, postural transfers (including sitting), and respiratory exercises. After hospital discharge, patients were referred to rehabilitation facilities. Physiotherapeutic interventions provided during ECMO support and after its discontinuation were feasible and safe.
The physiotherapeutic treatment of patients undergoing ECMO support includes several components and must be provided in a multidisciplinary context. The optimal approach depends on the patient's status, including sedation, level of consciousness, ECMO configuration, types of cannulas, and cannulation site.
2019 年冠状病毒病（COVID-19）大流行给医院环境中危重症患者的管理带来了严峻挑战。体外膜肺氧合（ECMO）支持已被证明在 SARS-CoV-2 爆发期间是一种救生支持。本综述的目的是描述 COVID-19 大流行期间接受 ECMO 支持的患者所接受的康复治疗。
我们在 PubMed 和 Scopus 上搜索了从数据库创建到 2021 年 6 月 30 日发表的英文研究。我们排除了社论、给编辑的信以及未描述 ECMO 支持期间康复程序的研究。我们还排除了那些不是用英文写的文章。
共确定了 50 篇文章。我们最终纳入了 9 项研究，其中 7 项为病例报告。只有两项研究有超过一名患者；一项观察性设计分析了 19 名患者的临床过程，另一项是三名患者的病例系列。体外支持时间从 9 天到 49 天不等，主要适应证为 COVID-19 相关急性呼吸窘迫综合征。康复治疗主要包括床上活动、体位转移（包括坐起）和呼吸练习。出院后，患者被转介到康复机构。在 ECMO 支持期间和停止后提供的物理治疗干预是可行和安全的。
接受 ECMO 支持的患者的物理治疗包括几个组成部分，必须在多学科背景下提供。最佳方法取决于患者的状况，包括镇静、意识水平、ECMO 配置、插管类型和插管部位。
