Purpose: This case study and evidence-based analysis aims to determine if active physical therapy is more effective than PROM alone in patients on Extracorporeal Membrane Oxygenation (ECMO). Background: Patients require ECMO for many different medical conditions, and it is currently controversial as to the level of physical therapy intervention provided to these patients. The general consensus to date is that Passive Range of Motion (PROM) is the only physical therapy intervention, if any, performed while patients are on ECMO. There are two different types of ECMO, Veno-Arterial (VA) and Veno-Venus (VV). Most commonly, the cannulas for VA ECMO are in the neck and the femoral artery. For VV ECMO, both cannulas are normally placed in the neck. Therefore, it is safer to ambulate patients on VV ECMO rather than VA ECMO, but ambulation at all continues to be controversial. Current research is sparse, and needs to be analyzed to determine what is safe and effective for this patient population. New research also needs to be performed focusing on ambulation with patients on ECMO because it is not currently the standard of care. Case Description: The patient selected for this case study and analysis is a ten-year-old male, admitted to the University of Arizona Medical Center with Acute Respiratory Distress requiring placement on Veno-Venus ECMO for 13 days. The physical therapy for this particular patient included PROM only while he was on ECMO, so outcomes for this patient cannot support ambulation on ECMO since it did not occur. However, this patient would have been a good candidate for active physical therapy and ambulation since he was on VV ECMO with a dual-lumen cannulation, and was a previously healthy young man. Outcomes: A review of current literature revealed that active physical therapy and ambulation of patients on ECMO can decrease the patients ICU stay, total hospital stay, time on mechanical ECMO and Physical Therapy, ventilation and tracheostomy, and risk for ICU-acquired weakness. This provides a better overall outcome for the patient. Integrating results from the studies found from this analysis is difficult due to the lack of research focused directly on ambulating patients on ECMO. However, this research does support the already established knowledge that early mobilization improves patient outcome in the ICU, and can therefore begin to be applied to patients on ECMO as well. Discussion: The overall quality of current research is relatively poor, consisting mostly of individual case studies and case series. Due to the difficulty in gathering a cohort group large enough to perform a randomized controlled trial for this patient population, there are no high level studies published to date looking at specifically ambulatory physical therapy for patients on ECMO. However, there is established research supporting ICU-acquired weakness and the benefits of early mobilization in this setting (Adler, 2012., Burtin, 2009., Deem, 2006., Morris, 2011., Pohlman,2010., Schweickert, 2009), and this data may be extrapolated towards the ECMO patient population as well. In the few studies that have been done, ambulatory physical therapy on ECMO has shown to be safe for the patient and does not cause significant adverse events to occur. This being said, more research needs to be done specifically looking at ambulatory physical therapy for patients on ECMO in order to determine an appropriate protocol that is accepted by physicians in the ICU setting.
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Extracorporeal Membrane Oxygenation, ECMO, ECMO and ambulating
Eldridge, Kaye. "Extracorporeal Membrane Oxygenation and Active Physical Therapy." (2014). http://digitalrepository.unm.edu/dpt/79