2011 OPEN FORUM Abstracts
EXTRACORPOREAL MEMBRANE OXYGENATION AS A MECHANISM FOR REHABILITATION WHILE AWAITING LUNG TRANSPLANTATION: PROGRAM DEVELOPMENT.
Walter L. Williford1, David Turner2, David Zaas4, Kyle Rehder2, Stacey Carmichael-Peterson2, Shu Lin3, R. Duane Davis3, Ira Cheifetz2; 1Respiratory Care, Duke University Hospital, Durham, NC; 2Pediatric Critical Care, Duke University Hospital, Durham, NC; 3Cardiothoracic Surgery, Duke University Hospital, Durham, NC; 4Medicine, Duke University Medical Center, Durham, NC
Objectives: Lung transplantation is an important therapeutic option for a number of illnesses, but outcomes in the setting of critical illness have been poor. In the most severely ill patients, Extracorporeal Membrane Oxygenation (ECMO) may be required for pre-transplant support, and in this context, both morbidity and mortality are high. Pre-transplant myopathy and deconditioning contribute to prolonged hospitalization and poor outcomes with critically ill patients. We describe the integration of a rehabilitation program including ambulation for three critically ill ECMO patients being bridged to lung transplantation. Methods: A multidisciplinary team including personnel from the pediatric critical care, respiratory care, and lung transplant services developed a program to rehabilitate lung transplant patients while on ECMO. Results: Three patients (16, 20, and 24 years of age) with end-stage cystic fibrosis, admitted to the Pediatric ICU for respiratory failure, were rehabilitated on ECMO while awaiting lung transplantation. Each underwent internal jugular vein cannulation with a double lumen cannula for venovenous ECMO followed by tracheostomy. Pre-transplant, each patient was treated with an aggressive pulmonary toilet regimen including intrapulmonary percussive ventilation and mucolytics to optimize secretion clearance and allow for weaning of mechanical ventilation. In addition, these patients underwent a rigorous physical therapy regimen that included passive exercise, sitting, standing, and ambulating with assistance. Ambulation on ECMO involved a coordinated effort among respiratory therapists, ECMO specialists, physicians, physical therapists, perfusionists, and nurses, to assure patient safety. All patients were successfully transplanted and weaned to room air tracheostomy collar within 24 hours. Conclusions: Rehabilitation and ambulation can be safely implemented during ECMO. Therapy and rehabilitation may lead to improved outcomes, shorter duration of mechanical ventilation, ICU stay, and hospital stay following lung transplantation. Programs of this nature may lead to changes in the management of patients awaiting lung transplantation. It is possible that increased utilization of ECMO prior to transplant may improve the potential for reconditioning, improving patient outcomes and post transplant length of stay. Additionally, these findings may have potential implications for all patients treated with ECMO. Sponsored Research - None