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Physical therapy in successful venoarterial extracorporeal membrane oxygenation bridge to orthotopic heart transplantation.

Abstract

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.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.Cardiovascular Institute, Stanford University, Palo Alto, California.Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31441558

Citation

Rinewalt, Daniel, et al. "Physical Therapy in Successful Venoarterial Extracorporeal Membrane Oxygenation Bridge to Orthotopic Heart Transplantation." Journal of Cardiac Surgery, 2019.
Rinewalt D, Shudo Y, Kawana M, et al. Physical therapy in successful venoarterial extracorporeal membrane oxygenation bridge to orthotopic heart transplantation. J Card Surg. 2019.
Rinewalt, D., Shudo, Y., Kawana, M., & Woo, Y. J. (2019). Physical therapy in successful venoarterial extracorporeal membrane oxygenation bridge to orthotopic heart transplantation. Journal of Cardiac Surgery, doi:10.1111/jocs.14220.
Rinewalt D, et al. Physical Therapy in Successful Venoarterial Extracorporeal Membrane Oxygenation Bridge to Orthotopic Heart Transplantation. J Card Surg. 2019 Aug 23; PubMed PMID: 31441558.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physical therapy in successful venoarterial extracorporeal membrane oxygenation bridge to orthotopic heart transplantation. AU - Rinewalt,Daniel, AU - Shudo,Yasuhiro, AU - Kawana,Masataka, AU - Woo,Y Joseph, Y1 - 2019/08/23/ PY - 2019/8/24/entrez KW - extracorporeal membrane oxygenation KW - organ allocation KW - orthotopic heart transplantation JF - Journal of cardiac surgery JO - J Card Surg N2 - 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. SN - 1540-8191 UR - https://www.unboundmedicine.com/medline/citation/31441558/Physical_therapy_in_successful_venoarterial_extracorporeal_membrane_oxygenation_bridge_to_orthotopic_heart_transplantation L2 - https://doi.org/10.1111/jocs.14220 DB - PRIME DP - Unbound Medicine ER -