Ambulation With Femoral Arterial Cannulation Can Be Safely Performed on Venoarterial Extracorporeal Membrane Oxygenation

Pasrija, Chetan; Mackowick, Kristen M.; Raithel, Maxwell; Tran, Douglas; Boulos, Francesca; Deatrick, Kristopher B.; Mazzeffi, Michael; Rector, Raymond; Pham, Si M.; Griffith, Bartley P.; Herr, Daniel; Kon, Zachary N.

doi:10.1016/j.athoracsur.2018.10.048

Cited by 59 publications

(54 citation statements)

References 16 publications

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“…Although data suggest that application of early mobilization is safe and feasible, its impact on mortality is not well defined. Limited studies have prospectively assessed the effect of early mobilization on patients receiving ECMO, but suggest a benefit [ 18 , 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients Managed without Positive Pressure Ventilation While on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Levin

Ciullo

Overton

et al. 2021

JCM

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Background: Extracorporeal membrane oxygenation (ECMO) has expanding indications for cardiopulmonary resuscitation including severe acute respiratory distress syndrome (ARDS). Despite the adjunct of ECMO for patients with severe ARDS, they often have prolonged mechanical ventilation and are subject to many of its inherent complications. Here, we describe patients who were cannulated for venovenous (VV) ECMO and were taken off positive pressure ventilation. Methods: This is a primary analysis of patients admitted at a tertiary medical center between the dates of August 2014 to January 2020 who were cannulated to ECMO for refractory respiratory failure. We included all patients ≥18 years old. Patients who were extubated or had a tracheostomy and taken off positive pressure while on ECMO were classified as “off positive pressure ventilation (PPV)” and were compared to patients who remained “on PPV” while on ECMO. Primary outcome was survival to hospital discharge. Secondary outcomes were ventilator free days at 30 days and 60 days after ECMO cannulation, time from cannulation to date of first out-of-bed (OOB), and hospital length of stay (LOS). Patient characteristics were derived from routine clinical information in the electronic health record (EHR). Categorical characteristics were compared using chi-square test or Fisher exact test. Continuous characteristics were compared using independent samples t-test or Wilcoxon–Mann–Whitney test. p-values were reported from all analysis. Results: Sixty-five patients were included in this retrospective analysis. Forty-eight were managed on ECMO with PPV and 17 patients were removed from PPV. Patients removed from PPV had significantly higher lung injury scores prior to cannulation (2.5 ± 0.6 vs. 1.04 ± 0.3; p = 0.031) and non-significantly longer duration of ventilation prior to ECMO (6.1 days ± 2.1 vs. 5.0 days ± 01.1; p = 0.634). One hundred percent (100%) of patients removed from PPV survived to hospital discharge compared to 45% who received PPV throughout their duration of ECMO management (p < 0.001). The mean ventilator free days at day 60 was 15 with PPV and 36 without PPV (p = 0.003). The average duration from cannulation to mobilization (i.e., out-of-bed) was 18 days with PPV and 7 days without PPV (p = 0.015). Conclusions: Patients taken off PPV while on ECMO had a very high likelihood of survival to discharge and were mobilized in half as many days. While this likely reflects patient selection, the benefit of early mobilization is well documented and the approach of extubating while on ECMO warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Patients Managed without Positive Pressure Ventilation While on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Levin

Ciullo

Overton

et al. 2021

JCM

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“…Ambulation is crucial to prevent complications, and early mobilization reduces intensive care unit and overall hospital length of stay. 10,11 Multiple studies have reported the feasibility and safety of ambulating patients with femoral cannulas. 10,12 Pasrija et al 10 described 15 cases of ambulatory femoral VA-ECMO, though just two of them were a bridge to heart transplant.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Multiple studies have reported the feasibility and safety of ambulating patients with femoral cannulas. 10,12 Pasrija et al 10 described 15 cases of ambulatory femoral VA-ECMO, though just two of them were a bridge to heart transplant. The ECMO cannulation and ambulation protocol is very similar to ours, median time from cannulation to out of bed was 3 days, time from cannulation to ambulation was 4 days and the median distance walked on the last day was 300 ft. 10…”

Section: Discussionmentioning

confidence: 99%

Peripheral femoral venoarterial extracorporeal membrane oxygenation as bridge to heart‐lung transplant omne iter incipit primus

et al. 2020

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Heart‐lung transplant (HLT) is a widely accepted modality for certain patients with advanced and refractory cardiopulmonary disease. Some of these patients are critically ill on the transplant waiting list, and venoarterial extracorporeal membrane oxygenation (VA‐ECMO) can be used as a bridge to transplantation. Although the experience with ECMO as a bridge to lung transplant is promising, there is limited evidence to use ECMO as a bridge to HLT. Femoral cannulation remains a concern for ambulation given the risk of bleeding and cannula complications despite studies reporting its safety. We present a case of a 56‐year‐old male with interstitial lung disease and severe secondary pulmonary hypertension, who was successfully bridged to HLT with ambulatory femoral VA‐ECMO.

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“…By avoiding insertion of cannulas in the vessels of either extremity, the authors propose a platform that would naturally facilitate mobilization of the patient, enhancing potential for pre‐habilitation in the initial phase of stabilization and recovery from decompensated cardiogenic shock 8,9 …”

mentioning

confidence: 99%

Invited commentary: “Adapting technology and rapid transitions to optimize management outcomes in mechanical circulatory support”

Brozzi

2021

J Card Surg

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Ambulation With Femoral Arterial Cannulation Can Be Safely Performed on Venoarterial Extracorporeal Membrane Oxygenation

Cited by 59 publications

References 16 publications

Characteristics of Patients Managed without Positive Pressure Ventilation While on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Characteristics of Patients Managed without Positive Pressure Ventilation While on Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome

Peripheral femoral venoarterial extracorporeal membrane oxygenation as bridge to heart‐lung transplant omne iter incipit primus

Invited commentary: “Adapting technology and rapid transitions to optimize management outcomes in mechanical circulatory support”

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