RT Journal Article SR Electronic T1 Active rehabilitation during ECMO as a bridge to lung transplantation JF Respiratory Care FD American Association for Respiratory Care SP respcare.02155 DO 10.4187/respcare.02155 A1 Kyle J. Rehder A1 David A. Turner A1 Matthew G. Hartwig A1 W. Lee Williford A1 Desiree Bonadonna A1 Richard J Walczak, Jr A1 R. Duane Davis A1 David Zaas A1 Ira M. Cheifetz YR 2012 UL http://rc.rcjournal.com/content/early/2012/12/04/respcare.02155.abstract AB 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 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 patients between April 2007 and May 2012 were identified for inclusion. One year survival for all patients was 100%, with one patient alive at 4 months post-transplant. The five patients participating in pre-transplant rehabilitation had shorter mean post-transplant length of mechanical ventilation (4 days vs. 34 days, p = 0.01), ICU stay (11 days vs. 45 days, p = 0.01), and hospital stay (26 days vs. 80 days, p = 0.01). No patients who participated in active rehabilitation had post-transplant myopathy, compared to three of four patients 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.