Maintaining Mobility in a Patient Who Is Pregnant and Has COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Case Report

Abstract

Objective Mobilization while receiving life support interventions, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), is a recommended intensive care unit (ICU) intervention to maintain physical function. The purpose of this case report is to describe a novel approach to implementing early mobility interventions for a patient who was pregnant and receiving ECMO while continuing necessary infectious disease precautions because of diagnosed coronavirus disease-19 (COVID-19). Methods (Case Description) A 27-year old woman who was pregnant was admitted to the ICU with COVID-19 and rapidly developed acute respiratory failure requiring 9 days of ECMO support. After a physical therapist consultation, the patient was standing at the bedside by hospital day 5 and ambulating by hospital day 9. Results The patient safely participated in physical therapy during ICU admission and was discharged to home with outpatient physical therapy follow-up after 14 days of hospitalization. Conclusion Early mobility is feasible during ECMO with COVID-19, and active participation in physical therapy, including in-room ambulation, may facilitate discharge to home. Innovative strategies to facilitate routine activity in a patient who is critically ill with COVID-19 require an established and highly trained team with a focus on maintaining function. Impact Early mobility while intubated, on ECMO, and infected with COVID-19 is feasible while adhering to infectious disease precautions when it is performed by an experienced interdisciplinary team.

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

“…Although COVID‐19 has challenged hospital settings to manage critical patients, rehabilitative interventions in those who have undergone awake ECMO support to treat COVID‐19‐related respiratory failure have contributed to improving outcomes, as emerged from the present review. Among the included papers, in three of them 13 , 17 , 18 patients gained significant functional improvements precisely because they were involved in early rehabilitation. It should be also highlighted that the findings of the present review seem to support the same hypotheses generated in a previously published research where rehabilitation for patients on awake ECMO was feasible and safe.…”

“…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 …”

“…Among those studies, one reported that rehabilitation was provided with the patient on ECMO support. 17 In that study by Mark and colleagues, the patient was approached on ECMO day 5, initiating an in‐bed range of motion exercises progressing toward increased mobility and walking on ECMO. 18 In another study by Oh and colleagues, the patient was waiting for lung transplantation.…”

“…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. In this regard, increased distances detected following physiotherapeutic intervention can be strictly related to it and can provide valuable insights into therapeutic progression.…”

Potential therapeutic effect of oxygen-ozone in controlling of COVID-19 disease

“…Numerous clinical trials and healing interventions presently purpose to recognize the most effective drug or combination against the disease. 7 8 Currently investigated approaches include antiviral (antivirals can be confirmed as harmless and active only in the context of randomized controlled clinical trial and anti-proinflammatory cytokines, anti-infectious and monoclonal antibodies, and passive immunotherapy (plasma therapy), especially in critical patients. 9 …”