Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation.

Abstract

BACKGROUND:

Patients with end-stage lung disease often progress to critical illness, which dramatically reduces their chance of survival following lung transplantation. Pre-transplant deconditioning has a significant impact on outcomes for all lung transplant patients, and is likely a major contributor to increased mortality in critically ill lung transplant recipients. The aim of this report is to describe a series of patients bridged to lung transplant with extracorporeal membrane oxygenation (ECMO) and to examine the potential impact of active rehabilitation and ambulation during pre-transplant ECMO.

METHODS:

This retrospective case series reviews all patients bridged to lung transplantation with ECMO at a single tertiary care lung transplant center. Pre-transplant ECMO patients receiving active rehabilitation and ambulation were compared to those patients who were bridged with ECMO but did not receive pre-transplant rehabilitation.

RESULTS:

Nine consecutive subjects between April 2007 and May 2012 were identified for inclusion. One-year survival for all subjects was 100%, with one subject alive at 4 months post-transplant. The 5 subjects participating in pre-transplant rehabilitation had shorter mean post-transplant mechanical ventilation (4 d vs 34 d, P = .01), ICU stay (11 d vs 45 d, P = .01), and hospital stay (26 d vs 80 d, P = .01). No subject who participated in active rehabilitation had post-transplant myopathy, compared to 3 of 4 subjects who did not participate in pre-transplant rehabilitation on ECMO.

CONCLUSIONS:

Bridging selected critically ill patients to transplant with ECMO is a viable treatment option, and active participation in physical therapy, including ambulation, may provide a more rapid post-transplantation recovery. This innovative strategy requires further study to fully evaluate potential benefits and risks.

• Authors: Kyle J Rehder, David A Turner, Matthew G Hartwig, W Lee Williford, Desiree Bonadonna, Richard J Walczak Jr, R Duane Davis, David Zaas, Ira M Cheifetz
• Journal: Respiratory care (Respir Care) Vol. 58 Issue 8 Pg. 1291-8 (Aug 2013) ISSN: 1943-3654 [Electronic] United States
• PMID: 23232742 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Critical Illness
• Extracorporeal Membrane Oxygenation (rehabilitation)
• Female
• Humans
• Length of Stay
• Lung Diseases (physiopathology, surgery, therapy)
• Lung Transplantation (mortality)
• Male
• Middle Aged
• Retrospective Studies
• Transplantation Conditioning (methods)
• Treatment Outcome
• Young Adult