Chetan Pasrija1, Kristen M Mackowick2, Maxwell Raithel2, Douglas Tran2, Francesca M Boulos2, Kristopher B Deatrick2, Michael A Mazzeffi3, Raymond Rector4, Si M Pham5, Bartley P Griffith2, Daniel L Herr6, Zachary N Kon7. 1. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: cpasrija@som.umaryland.edu. 2. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 3. Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland. 4. Perfusion Services, University of Maryland Medical Center, Baltimore, Maryland. 5. Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida. 6. Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. 7. Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
Abstract
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support can be associated with significant deconditioning due to the requirement for strict bedrest as a result of femoral arterial cannulation. To address this issue, we evaluated our experience with ambulation in patients with peripheral femoral cannulation for VA-ECMO. METHODS: All patients that were peripherally cannulated for VA-ECMO over a 2-year period were retrospectively reviewed. Patients that ambulated at least once while supported with VA-ECMO were included in the analysis. The primary outcomes were safety and feasibility of ambulation, defined as the absence of major bleeding, vascular, or decannulation events. RESULTS: Of 104 patients placed on VA-ECMO, 15 ambulated with a femoral arterial cannula. Forty-six percent of patients were placed on VA-ECMO for decompensated heart failure, and 54% for massive pulmonary embolism. Twenty-seven percent of patients were cannulated during active cardiopulmonary resuscitation. The median length of time from cannulation to out of bed was 3 (range, 0 to 26) days. The median length of time from cannulation to initial ambulation was 4 (range, 1 to 42) days. The median distance of the first postcannulation walk was 300 feet. Neither flow nor speed decreased during or after ambulation. There were no major bleeding events, vascular complications, or decannulation events associated with ambulation. The median intensive care unit length of stay and hospital length of stay were 12 and 21 days, respectively. One-year survival was 100% for ambulating patients. CONCLUSIONS: Ambulating patients supported with VA-ECMO, despite femoral arterial cannulation, appears feasible and safe in carefully selected patients.
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) support can be associated with significant deconditioning due to the requirement for strict bedrest as a result of femoral arterial cannulation. To address this issue, we evaluated our experience with ambulation in patients with peripheral femoral cannulation for VA-ECMO. METHODS: All patients that were peripherally cannulated for VA-ECMO over a 2-year period were retrospectively reviewed. Patients that ambulated at least once while supported with VA-ECMO were included in the analysis. The primary outcomes were safety and feasibility of ambulation, defined as the absence of major bleeding, vascular, or decannulation events. RESULTS: Of 104 patients placed on VA-ECMO, 15 ambulated with a femoral arterial cannula. Forty-six percent of patients were placed on VA-ECMO for decompensated heart failure, and 54% for massive pulmonary embolism. Twenty-seven percent of patients were cannulated during active cardiopulmonary resuscitation. The median length of time from cannulation to out of bed was 3 (range, 0 to 26) days. The median length of time from cannulation to initial ambulation was 4 (range, 1 to 42) days. The median distance of the first postcannulation walk was 300 feet. Neither flow nor speed decreased during or after ambulation. There were no major bleeding events, vascular complications, or decannulation events associated with ambulation. The median intensive care unit length of stay and hospital length of stay were 12 and 21 days, respectively. One-year survival was 100% for ambulating patients. CONCLUSIONS: Ambulating patients supported with VA-ECMO, despite femoral arterial cannulation, appears feasible and safe in carefully selected patients.
Authors: Joseph E Tonna; Darryl Abrams; Daniel Brodie; John C Greenwood; Jose Alfonso Rubio Mateo-Sidron; Asad Usman; Eddy Fan Journal: ASAIO J Date: 2021-06-01 Impact factor: 3.826
Authors: Sagar Dave; Aakash Shah; Samuel Galvagno; Kristen George; Ashley R Menne; Daniel J Haase; Brian McCormick; Raymond Rector; Siamak Dahi; Ronson J Madathil; Kristopher B Deatrick; Mehrdad Ghoreishi; James S Gammie; David J Kaczorowski; Thomas M Scalea; Jay Menaker; Daniel Herr; Eric Krause; Ali Tabatabai Journal: Membranes (Basel) Date: 2021-04-02