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.
- extracorporeal membrane oxygenation
- ECMO
- lung transplant
- rehabilitation
- cystic fibrosis
- respiratory failure
- mechanical ventilation
- hypoxia
- hypercapnia
- acute lung injury
Footnotes
- Correspondence: Kyle J Rehder MD, Division of Pediatric Critical Care, Duke University Medical Center, Box 3046, Durham NC 27710. E-mail: kyle.rehder{at}duke.edu.
Drs Rehder and Turner are co-first authors.
The authors have disclosed no conflicts of interest.
Dr Rehder presented a version of this paper at the American College of Chest Physicians International Scientific Assembly, held October 20–25, 2012, in Atlanta, Georgia, and at the annual conference of the Extracorporeal Life Support Organization, held September 14–16, 2012, in Seattle, Washington.
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