Safety and Feasibility of Early Physical Therapy for Patients on Extracorporeal Membrane Oxygenator: University of Maryland Medical Center Experience
OBJECTIVES:To examine the feasibility and safety of mobilizing patients while on extracorporeal membranous oxygenation support. DESIGN:Retrospective cohort study. SETTING:Medical and Surgical ICUs in a large tertiary care hospital in the United States. PATIENTS:Adults supported on extracorporeal mem...
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| Veröffentlicht in: | Critical care medicine 2018-01, Vol.46 (1), p.53-59 |
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| creator | Wells, Chris L. Forrester, Jenny Vogel, Joshua Rector, Raymond Tabatabai, Ali Herr, Daniel |
| description | OBJECTIVES:To examine the feasibility and safety of mobilizing patients while on extracorporeal membranous oxygenation support.
DESIGN:Retrospective cohort study.
SETTING:Medical and Surgical ICUs in a large tertiary care hospital in the United States.
PATIENTS:Adults supported on extracorporeal membranous oxygenation from January 2014 to December 2015.
MEASUREMENTS AND MAIN RESULTS:We reviewed the medical records from physical therapy, perfusion, and intensivists to obtain the number and type of physical therapy interventions and discharge status; extracorporeal membranous oxygenation type and description of support, cannulation sites; and risk management details of adverse effects, if any. Of 254 patients supported on extracorporeal membranous oxygenation, 167 patients (66.7%) received a total of 607 physical therapy sessions while on extracorporeal membranous oxygenation support. In this cohort, 134 patients (80.2%) had at least one femoral cannula during physical therapy intervention. Sixty-six of the 167 patients (39.5%) were supported on extracorporeal membranous oxygenation with bifemoral cannulas, and 44 (26.3%) were on veno-arterial extracorporeal membranous oxygenation. A dual lumen catheter was only used in five cases. Twenty-five patients (15%) (13 bifemoral cases) participated in standing or ambulation activities. Seventy-five patients (68.8%) who were successfully weaned from extracorporeal membranous oxygenation were discharged to a rehabilitation facility; 26 patients (23.8%) went home. Three minor events (< 0.5%) involving two episodes of arrhythmias and a hypotension event interrupted the therapy sessions, but mobility activities and exercises resumed that day. No major events were reported.
CONCLUSIONS:With a highly trained multidisciplinary team and a focus on restoring function, it is feasible and safe to deliver early rehabilitation including standing and ambulation to patients on extracorporeal membranous oxygenation support even those with femoral cannulation sites with veno-arterial extracorporeal membranous oxygenation and veno-venous extracorporeal membranous oxygenation. |
| doi_str_mv | 10.1097/CCM.0000000000002770 |
| format | Article |
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DESIGN:Retrospective cohort study.
SETTING:Medical and Surgical ICUs in a large tertiary care hospital in the United States.
PATIENTS:Adults supported on extracorporeal membranous oxygenation from January 2014 to December 2015.
MEASUREMENTS AND MAIN RESULTS:We reviewed the medical records from physical therapy, perfusion, and intensivists to obtain the number and type of physical therapy interventions and discharge status; extracorporeal membranous oxygenation type and description of support, cannulation sites; and risk management details of adverse effects, if any. Of 254 patients supported on extracorporeal membranous oxygenation, 167 patients (66.7%) received a total of 607 physical therapy sessions while on extracorporeal membranous oxygenation support. In this cohort, 134 patients (80.2%) had at least one femoral cannula during physical therapy intervention. Sixty-six of the 167 patients (39.5%) were supported on extracorporeal membranous oxygenation with bifemoral cannulas, and 44 (26.3%) were on veno-arterial extracorporeal membranous oxygenation. A dual lumen catheter was only used in five cases. Twenty-five patients (15%) (13 bifemoral cases) participated in standing or ambulation activities. Seventy-five patients (68.8%) who were successfully weaned from extracorporeal membranous oxygenation were discharged to a rehabilitation facility; 26 patients (23.8%) went home. Three minor events (< 0.5%) involving two episodes of arrhythmias and a hypotension event interrupted the therapy sessions, but mobility activities and exercises resumed that day. No major events were reported.
CONCLUSIONS:With a highly trained multidisciplinary team and a focus on restoring function, it is feasible and safe to deliver early rehabilitation including standing and ambulation to patients on extracorporeal membranous oxygenation support even those with femoral cannulation sites with veno-arterial extracorporeal membranous oxygenation and veno-venous extracorporeal membranous oxygenation.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000002770</identifier><identifier>PMID: 29053491</identifier><language>eng</language><publisher>United States: by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Early Medical Intervention ; Extracorporeal Membrane Oxygenation - rehabilitation ; Feasibility Studies ; Female ; Hospitals, University ; Humans ; Interdisciplinary Communication ; Intersectoral Collaboration ; Male ; Middle Aged ; Patient Safety ; Physical Therapy Modalities ; Young Adult</subject><ispartof>Critical care medicine, 2018-01, Vol.46 (1), p.53-59</ispartof><rights>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4670-1dbed5ef75e4b9c5d1db86a2a49cbc2130d8cfa1643423daa3651c26a53ff18e3</citedby><cites>FETCH-LOGICAL-c4670-1dbed5ef75e4b9c5d1db86a2a49cbc2130d8cfa1643423daa3651c26a53ff18e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29053491$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wells, Chris L.</creatorcontrib><creatorcontrib>Forrester, Jenny</creatorcontrib><creatorcontrib>Vogel, Joshua</creatorcontrib><creatorcontrib>Rector, Raymond</creatorcontrib><creatorcontrib>Tabatabai, Ali</creatorcontrib><creatorcontrib>Herr, Daniel</creatorcontrib><title>Safety and Feasibility of Early Physical Therapy for Patients on Extracorporeal Membrane Oxygenator: University of Maryland Medical Center Experience</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVES:To examine the feasibility and safety of mobilizing patients while on extracorporeal membranous oxygenation support.
DESIGN:Retrospective cohort study.
SETTING:Medical and Surgical ICUs in a large tertiary care hospital in the United States.
PATIENTS:Adults supported on extracorporeal membranous oxygenation from January 2014 to December 2015.
MEASUREMENTS AND MAIN RESULTS:We reviewed the medical records from physical therapy, perfusion, and intensivists to obtain the number and type of physical therapy interventions and discharge status; extracorporeal membranous oxygenation type and description of support, cannulation sites; and risk management details of adverse effects, if any. Of 254 patients supported on extracorporeal membranous oxygenation, 167 patients (66.7%) received a total of 607 physical therapy sessions while on extracorporeal membranous oxygenation support. In this cohort, 134 patients (80.2%) had at least one femoral cannula during physical therapy intervention. Sixty-six of the 167 patients (39.5%) were supported on extracorporeal membranous oxygenation with bifemoral cannulas, and 44 (26.3%) were on veno-arterial extracorporeal membranous oxygenation. A dual lumen catheter was only used in five cases. Twenty-five patients (15%) (13 bifemoral cases) participated in standing or ambulation activities. Seventy-five patients (68.8%) who were successfully weaned from extracorporeal membranous oxygenation were discharged to a rehabilitation facility; 26 patients (23.8%) went home. Three minor events (< 0.5%) involving two episodes of arrhythmias and a hypotension event interrupted the therapy sessions, but mobility activities and exercises resumed that day. No major events were reported.
CONCLUSIONS:With a highly trained multidisciplinary team and a focus on restoring function, it is feasible and safe to deliver early rehabilitation including standing and ambulation to patients on extracorporeal membranous oxygenation support even those with femoral cannulation sites with veno-arterial extracorporeal membranous oxygenation and veno-venous extracorporeal membranous oxygenation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Early Medical Intervention</subject><subject>Extracorporeal Membrane Oxygenation - rehabilitation</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Interdisciplinary Communication</subject><subject>Intersectoral Collaboration</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Safety</subject><subject>Physical Therapy Modalities</subject><subject>Young Adult</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc9u1DAQxi0EokvhDRDykUvK-F-ccEPRliJ11Uq058hxxmwgGwc72zYPwvvWy24rxKH1xZpP3_zGno-Q9wxOGJT6U1WtTuCfw7WGF2TBlIAMeClekgVACZmQpTgib2L8CcCk0uI1OeIlqKSzBfnz3TicZmqGlp6iiV3T9V2qvaNLE_qZXq7n2FnT06s1BjPO1PlAL83U4TBF6ge6vJuCsT6MPmCyrXDTBDMgvbibf-BgJh8-0-uhu8EQD-CVCXO_G7jC9i-6SiwMiTRiSFyLb8krZ_qI7w73Mbk-XV5VZ9n5xddv1ZfzzMpcQ8baBluFTiuUTWlVm4QiN9zI0jaWMwFtYZ1huRSSi9YYkStmeW6UcI4VKI7Jxz13DP73FuNUb7posU-vQ7-NNSuVBC1A62SVe6sNPsaArh5Dt0k_qRnUu0DqFEj9fyCp7cNhwrbZYPvY9JBAMhR7w63v0xLir357i6Fep11O6-fY8onWnU1wmWccWAEsVdlO0uIeZXipxQ</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Wells, Chris L.</creator><creator>Forrester, Jenny</creator><creator>Vogel, Joshua</creator><creator>Rector, Raymond</creator><creator>Tabatabai, Ali</creator><creator>Herr, Daniel</creator><general>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180101</creationdate><title>Safety and Feasibility of Early Physical Therapy for Patients on Extracorporeal Membrane Oxygenator: University of Maryland Medical Center Experience</title><author>Wells, Chris L. ; Forrester, Jenny ; Vogel, Joshua ; Rector, Raymond ; Tabatabai, Ali ; Herr, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4670-1dbed5ef75e4b9c5d1db86a2a49cbc2130d8cfa1643423daa3651c26a53ff18e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Early Medical Intervention</topic><topic>Extracorporeal Membrane Oxygenation - rehabilitation</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Interdisciplinary Communication</topic><topic>Intersectoral Collaboration</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Safety</topic><topic>Physical Therapy Modalities</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wells, Chris L.</creatorcontrib><creatorcontrib>Forrester, Jenny</creatorcontrib><creatorcontrib>Vogel, Joshua</creatorcontrib><creatorcontrib>Rector, Raymond</creatorcontrib><creatorcontrib>Tabatabai, Ali</creatorcontrib><creatorcontrib>Herr, Daniel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wells, Chris L.</au><au>Forrester, Jenny</au><au>Vogel, Joshua</au><au>Rector, Raymond</au><au>Tabatabai, Ali</au><au>Herr, Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and Feasibility of Early Physical Therapy for Patients on Extracorporeal Membrane Oxygenator: University of Maryland Medical Center Experience</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>46</volume><issue>1</issue><spage>53</spage><epage>59</epage><pages>53-59</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract>OBJECTIVES:To examine the feasibility and safety of mobilizing patients while on extracorporeal membranous oxygenation support.
DESIGN:Retrospective cohort study.
SETTING:Medical and Surgical ICUs in a large tertiary care hospital in the United States.
PATIENTS:Adults supported on extracorporeal membranous oxygenation from January 2014 to December 2015.
MEASUREMENTS AND MAIN RESULTS:We reviewed the medical records from physical therapy, perfusion, and intensivists to obtain the number and type of physical therapy interventions and discharge status; extracorporeal membranous oxygenation type and description of support, cannulation sites; and risk management details of adverse effects, if any. Of 254 patients supported on extracorporeal membranous oxygenation, 167 patients (66.7%) received a total of 607 physical therapy sessions while on extracorporeal membranous oxygenation support. In this cohort, 134 patients (80.2%) had at least one femoral cannula during physical therapy intervention. Sixty-six of the 167 patients (39.5%) were supported on extracorporeal membranous oxygenation with bifemoral cannulas, and 44 (26.3%) were on veno-arterial extracorporeal membranous oxygenation. A dual lumen catheter was only used in five cases. Twenty-five patients (15%) (13 bifemoral cases) participated in standing or ambulation activities. Seventy-five patients (68.8%) who were successfully weaned from extracorporeal membranous oxygenation were discharged to a rehabilitation facility; 26 patients (23.8%) went home. Three minor events (< 0.5%) involving two episodes of arrhythmias and a hypotension event interrupted the therapy sessions, but mobility activities and exercises resumed that day. No major events were reported.
CONCLUSIONS:With a highly trained multidisciplinary team and a focus on restoring function, it is feasible and safe to deliver early rehabilitation including standing and ambulation to patients on extracorporeal membranous oxygenation support even those with femoral cannulation sites with veno-arterial extracorporeal membranous oxygenation and veno-venous extracorporeal membranous oxygenation.</abstract><cop>United States</cop><pub>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>29053491</pmid><doi>10.1097/CCM.0000000000002770</doi><tpages>7</tpages></addata></record> |
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| ispartof | Critical care medicine, 2018-01, Vol.46 (1), p.53-59 |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Adult Aged Aged, 80 and over Early Medical Intervention Extracorporeal Membrane Oxygenation - rehabilitation Feasibility Studies Female Hospitals, University Humans Interdisciplinary Communication Intersectoral Collaboration Male Middle Aged Patient Safety Physical Therapy Modalities Young Adult |
| title | Safety and Feasibility of Early Physical Therapy for Patients on Extracorporeal Membrane Oxygenator: University of Maryland Medical Center Experience |
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