Early rehabilitation after lung transplantation with extracorporeal membrane oxygenation (ECMO) of COVID-19 patient: a case report

Abstract

Even when severe acute respiratory syndrome coronavirus 2-related coronavirus disease 2019 is treated with first-line drugs, it progresses and leads to irreversible loss of lung function in some critically ill patients, and lung transplantation is an effective treatment for end-stage chronic pulmonary disease. This case report mainly describes the rehabilitation of a 66-year-old female patient with severe COVID-19 after bilateral lung transplantation. The old patient had a body mass index of 31.2 kg/m 2 . She underwent bilateral lung transplantation due to severe and irreversible injury of both lungs.Long-term mechanical ventilation and extracorporeal membrane oxygenation (ECMO) treatment and preoperative and postoperative high-dose corticosteroid therapy and due to the size of the donor lung does not match the size of the recipient's diseased lung, and the right middle lobe of the graft is removed before transplantation. Weaning from the ventilator failed due to weak neuromuscular drive, and muscle strength.A full, personalized pulmonary rehabilitation program was initiated with the help of the physical therapists, the respiratory therapy, the doctors, the nurses and psychotherapist team based on the functional levels. The rehabilitation intervention was conducted on postoperative day 4, This included posture management, airway clearance techniques, respiratory training, muscle strength training, transfer training, daily therapeutic bronchoscopy and psychological support. The ECMO was removed successfully on the fifth day. the patient's physical function, muscle strength and the quality of life has been improved. The good prognosis after rehabilitation indicates that early rehabilitation intervention is effective and feasible and safety for patients after lung transplantation.

Extracorporeal membrane oxygenation and rehabilitation in patients with COVID‐19: A scoping review

“…We ultimately included nine studies, 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 seven of which were case reports. 14 , 15 , 16 , 17 , 18 , 19 , 21 Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients, 20 and a case series of three patients. 13 …”

“…Two of them underwent lung transplantation to treat the COVID‐19 sequelae, and they received postoperative rehabilitation after surgery. 13 , 16 In their case, ECMO support was used as a bridge to transplantation. However, it also appears clear that the rehabilitative practice was not directly provided during ECMO support, and consequently, it cannot be intended as a novel contribution to the expected standards.…”

“…The outcome measures used to detect clinical improvements directly related to rehabilitation were primarily linked to the patient’s ability to cooperate, muscle strength, physical function, performance in activities of daily living, and dyspnea intensity. 16 These variables, taken together, can express the capacity of patients to pursue realistic outcomes in critical settings and can direct the team efforts toward a feasible therapeutic pathway. Thus, the studies describing rehabilitative activities not expressly provided during ECMO support have furnished an interesting algorithm to be used when planning or investigating rehabilitation in patients on or weaned off ECMO support.…”

“…Thus, the studies describing rehabilitative activities not expressly provided during ECMO support have furnished an interesting algorithm to be used when planning or investigating rehabilitation in patients on or weaned off ECMO support. 16 …”

“…Thus, the studies describing rehabilitative activities not expressly provided during ECMO support have furnished an interesting algorithm to be used when planning or investigating rehabilitation in patients on or weaned off ECMO support. 16 Another consideration should be made on the utility of calculating the patients' walked meters reported in one study. 17 It is a simple method allowing clinicians to evaluate the quality and feasibility of a given physical treatment and the residual physical capacity of patients.…”