Safety and Feasibility of an Early Mobilization Protocol for Patients with Femoral Intra-Aortic Balloon Pumps as Bridge to Heart Transplant

Abstract

Intra-aortic balloon pumps (IABPs) can be used to provide hemodynamic support in patients with end-stage heart failure as a bridge to transplantation (BTT). The IABP is commonly inserted via the common femoral artery, which can limit patients’ mobility. The Ramsey protocol, developed by a critical care physical therapist, allows patients with femoral IABPs to ambulate with the assistance of a tilt table. The aim of this study was to determine the safety and feasibility of a modified Ramsey protocol for early mobilization of patients with femoral IABPs as BTT. This is a retrospective single-center review of patients with femoral IABPs as BTT using a tilt table protocol from May 2019 to May 2020. Primary outcomes were time to successful ambulation, number of successful ambulation events, and ambulation-associated adverse events, including IABP augmentation, waveform, positioning changes, and vascular complications at the insertion site. Twenty-four patients (mean age 55 ± 16 years) underwent femoral IABP insertion as BTT and were mobilized following our protocol. Nineteen patients (79.2%) successfully ambulated with a median of three sessions (interquartile range, 2–4) per patient. The median time from IABP insertion to ambulation was 3 days (interquartile range, 2–5). Twenty-one patients underwent heart transplantation, of which all 19 who ambulated were successfully bridged to transplantation. Early mobilization in select patients with femoral IABPs can be performed safely and successfully, avoiding the deleterious effects of bed rest that have been historically seen in this patient population.

Ambulation of Patients With In Situ Femoral Intraaortic Balloon Pump While Awaiting Heart Transplantation

“…Although two prior, single-center experiences prove feasibility and safety ambulating these patients, our experience extends these data with longer support periods, more ambulation sessions and further walk distances during these sessions. 5,6 Prolonged bed rest has multiple deleterious effects on muscle mass, bone mineral density, and the cardiovascular system, and these effects are magnified by critical illnesses and ambulation with a femoral IABP may counteract theses deleterious outcomes. 7 Our simplified ambulation process, allowing patients to walk with an unrestricted, natural gait, decreases necessary resources to ambulate these patients and will allow other centers to more easily replicate our experience (Supplemental Digital Content 3, http://links.lww.com/ASAIO/B20).…”

“…4 Preliminary experience from two centers using similar protocol showed that ambulation of such patients is both safe and feasible. 5,6 Accordingly, we undertook ambulation of patients with femoral IABP while awaiting heart transplantation at our center. Herein, we report our experience with ambulation of patients with a novel nonrestrictive ambulation protocol which facilitated greater ambulation distances, increased patient satisfaction and required fewer resources.…”

A bridge too far? Prolonged intra-aortic balloon pump support prior to heart transplantation

“…However, with meticulous nursing care and physiotherapy, these risks can be mitigated, and this case therefore demonstrates that the femoral IABP can be safely and effectively used for longer term support if necessary. Such approaches may become more common with the development of novel mobilisation protocols for patients supported with femoral IABPs 5 which will permit more intensive physiotherapy and may therefore improve bridging efficacy and post-transplant outcomes.…”

Mobility Checklist for Patients With Advanced Heart Failure and a Femoral Intra-aortic Balloon Pump

“…Emerging literature shows that mobilization of patients with a femoral IABP is safe and feasible 26–28. Ramsey et al26 published a protocol to guide mobilization of patients with a femoral IABP.…”

“…Emerging literature shows that mobilization of patients with a femoral IABP is safe and feasible. [26][27][28] Ramsey et al 26 published a protocol to guide mobilization of patients with a femoral IABP. We appreciated how this protocol described techniques on how to mobilize patients with a femoral IABP and was organized by phase of mobility.…”