Department of Physical Therapy, Ivester College of Health Sciences, Brenau University, Gainesville, GA, USA.
Department of Rehabilitation Therapy, Emory University Hospital, Atlanta, GA, USA.
Perfusion. 2024 May;39(4):840-848. doi: 10.1177/02676591231159570. Epub 2023 Feb 27.
Physical therapy (PT) utilization in patients requiring mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) has been reported; however, little is known about intensive rehabilitation and associated outcomes in patients requiring extended complex MCS and/or ECMO support. Authors sought to explore safety, feasibility and outcomes associated with active rehabilitation in patients requiring prolonged advanced MCS/ECMO support. Single-center retrospective series evaluated functional, clinical, and longitudinal outcomes of sample of eight critically ill, adult (≥18 years of age) patients who underwent a intensive rehabilitation while receiving prolonged MCS/ECMO through advanced configurations including: venovenous (VV-ECMO), venoarterial (VA-ECMO), oxygenator with right ventricular assist device (Oxy-RVAD) and right ventricular assist device (RVAD). 406 sessions were conducted; 246 during provision of advanced MCS/ECMO support. Incidence of major adverse events-accidental decannulation, migration of cannulas, circuit failure, hemorrhage, major flow limitations, and major hemodynamic instability-was 1.2 events per 100 sessions. None of reported major adverse events impeded longitudinal ability to participate in PT. Increased time to PT initiation was associated with a statistically significant increase in intensive care unit (ICU) length-of-stay (β1 1.93, CI 0.55-3.30) and reduced ambulatory distance during last session on MCS/ECMO (β1 -47.64, CI - 93.93, -1.66). All patients survived to hospital discharge and 12 months from sentinel hospitalization. Amongst those patients discharged to an inpatient rehabilitation center ( = 4), all were discharged home within 3 months. Findings support the safety and feasibility of active rehabilitational PT in patients requiring extended durations of advanced MCS/ECMO support. Moreover, it highlights potentially associated benefits of this degree of intensive rehabilitation for these unique patients. Further investigation is needed to identify associations with longitudinal clinical outcomes, as well as predictors of success in this population.
物理治疗（PT）在需要机械循环支持（MCS）和体外膜肺氧合（ECMO）的患者中的应用已有报道；然而，对于需要延长复杂 MCS 和/或 ECMO 支持的患者的强化康复及其相关结局知之甚少。作者旨在探讨在需要延长高级 MCS/ECMO 支持的患者中进行积极康复治疗的安全性、可行性和结局。单中心回顾性系列评估了 8 例危重成人（≥18 岁）患者的功能、临床和纵向结局，这些患者在接受包括以下高级配置的延长 MCS/ECMO 治疗时接受了强化康复治疗：静脉-静脉（VV-ECMO）、静脉-动脉（VA-ECMO）、带有右心室辅助装置的氧合器（Oxy-RVAD）和右心室辅助装置（RVAD）。共进行了 406 次治疗，其中 246 次是在提供高级 MCS/ECMO 支持时进行的。主要不良事件（意外拔管、导管移位、回路故障、出血、主要血流限制和主要血流动力学不稳定）的发生率为每 100 次治疗 1.2 次。报告的主要不良事件均未妨碍患者进行长期的 PT。PT 开始时间的增加与 ICU 住院时间的显著增加相关（β1 1.93，CI 0.55-3.30）和在 MCS/ECMO 上最后一次治疗时的步行距离减少相关（β1 -47.64，CI -93.93，-1.66）。所有患者均存活至出院，且从住院时起存活 12 个月。在出院至住院康复中心的患者中（n=4），所有患者均在 3 个月内出院回家。研究结果支持在需要延长高级 MCS/ECMO 支持时间的患者中进行积极康复治疗的安全性和可行性。此外，这强调了这种程度的强化康复对这些特殊患者的潜在益处。需要进一步的研究来确定与纵向临床结局的关联，以及确定该人群中成功的预测因素。
