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Physical therapy in successful venoarterial extracorporeal membrane oxygenation bridge to orthotopic heart transplantation
Author(s) -
Rinewalt Daniel,
Shudo Yasuhiro,
Kawana Masataka,
Woo Y. Joseph
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14220
Subject(s) - medicine , extracorporeal membrane oxygenation , cardiogenic shock , heart transplantation , rehabilitation , transplantation , heart failure , cardiomyopathy , intensive care medicine , surgery , cardiology , physical therapy , myocardial infarction
Background Venoarterial extracorporeal membrane oxygenation (VA‐ECMO) is a temporary mechanical circulatory support system that may be used as a lifesaving therapy for patients in acute heart failure and as a bridge to definitive management. Physical therapy in these patients remains challenging, with limited protocols to guide practitioners. Methods We describe a case of a 37‐year‐old gentleman who presented with familial cardiomyopathy and cardiogenic shock. Results Our patient underwent urgent peripheral venoarterial extracorporeal membrane oxygenation (VA‐ECMO) followed by successful heart transplantation. While on ECMO support he was enrolled in a physical therapy program that included the VitalGo Tilt Bed to improve lower body weight bearing while avoiding hip flexion and damage to the peripheral ECMO cannulae. The patient was discharged home expeditiously after heart transplant due to aggressive physical rehabilitation while on full VA‐ECMO support. Conclusions Early intensive physical rehabilitation is feasible and safe and may result in improved outcomes and expeditious discharge in VA ECMO patients. Protocol driven multidisciplinary physical therapy with a patient on femorally cannulated VA‐ECMO retains the advantages of lower extremity peripheral cannulation while eliminating the risks of immobility. The new UNOS allocation system may result in a successful bridge to transplantation in patients on VA‐ECMO due to the increased prioritization of this population to receive donor organs.