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Hileman BA, Martucci G, Subramanian H. Metabolic support for patients on extra-corporeal membrane oxygenation. Curr Opin Crit Care 2024; 30:305-310. [PMID: 38841988 DOI: 10.1097/mcc.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The purpose of the review is to summarize recent research on metabolic support during extracorporeal membrane oxygenation. In this review, we cover the evidence on nutritional supplementation, both the route of supplementation, timing of initiation of supplementation as well as quantities of supplementation needed. In addition, we discuss the recent trend in awake extracorporeal membrane oxygenation (ECMO) and its benefits to patients. RECENT FINDINGS As ECMO use continues to increase over the last few years, for both cardiovascular as well as respiratory failure, the need to optimize the metabolic states of patients has arisen. Increasing evidence has pointed towards this hitherto unexplored domain of patient care having a large impact on outcomes. Additionally, strategies such as awake ECMO for select patients has allowed them to preserve muscle mass which could aid in a faster recovery. SUMMARY There is a role of optimal metabolic support in the early recovery of patients on ECMO that is currently under-recognized. Future directions of research that aim to improve post ECMO outcomes must focus on this area.
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Affiliation(s)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, ISMETT, Palermo, Italy
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Rivera JD, Fox ES, Fernando SM, Tran A, Brodie D, Fan E, Fowles JA, Hodgson CL, Tonna JE, Rochwerg B. Physical Rehabilitation and Mobilization in Patients Receiving Extracorporeal Life Support: A Systematic Review. Crit Care Explor 2024; 6:e1095. [PMID: 38787294 PMCID: PMC11132346 DOI: 10.1097/cce.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES We planned to synthesize evidence examining the potential efficacy and safety of performing physical rehabilitation and/or mobilization (PR&M) in adult patients receiving extracorporeal life support (ECLS). DATA SOURCES We included any study that compared PR&M to no PR&M or among different PR&M strategies in adult patients receiving any ECLS for any indication and any cannulation. We searched seven electronic databases with no language limitations. STUDY SELECTION AND DATA EXTRACTION Two reviewers, independently and in duplicate, screened all citations for eligibility. We used the Cochrane Risk of Bias 2 and Cochrane Risk Of Bias In Non-randomized Studies of Interventions tools to assess individual study risk of bias. Although we had planned for meta-analysis, this was not possible due to insufficient data, so we used narrative and tabular data summaries for presenting results. We assessed the overall certainty of the evidence for each outcome using the Grading of Recommendations Assessment, Development, and Evaluation framework. DATA SYNTHESIS We included 17 studies that enrolled 996 patients. Most studies examined venovenous extracorporeal membrane oxygenation (ECMO) and/or venoarterial ECMO as a bridge to recovery in the ICU. We found an uncertain effect of high-intensity/active PR&M on mortality, duration of mechanical ventilation, ICU length of stay, hospital length of stay, or quality of life compared with low-intensity/passive PR&M in patients receiving ECLS (very low certainty due to very serious imprecision). There was similarly an uncertain effect on safety events including clinically important bleeding, spontaneous intracerebral hemorrhage, limb ischemia, accidental decannulation, or ECLS circuit dysfunction (very low certainty due to very serious risk of bias and imprecision). CONCLUSIONS Based on the currently available summary of evidence, there is an uncertain effect of high-intensity/active PR&M on patient important outcomes or safety in patients receiving ECLS. Despite indirect data from other populations suggesting potential benefit of high-intensity PR&M in the ICU; further high-quality randomized trials evaluating the benefits and risks of physical therapy and/or mobilization in this population are needed.
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Affiliation(s)
- Julian D Rivera
- Faculty of Medicine, University of Antioquia, Medellín, Antioquia, Colombia
| | - Edward S Fox
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Shannon M Fernando
- Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alexandre Tran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jo-Anne Fowles
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- The Alfred Hospital, Melbourne, VIC, Australia
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Polastri M, Eden A, Swol J. Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation. Perfusion 2024; 39:115S-126S. [PMID: 38651577 DOI: 10.1177/02676591231226289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND PURPOSE Current information on the latest rehabilitative practices is limited, with previous reviews only covering data up to October 2021, and some considering only patients on awake ECMO or with COVID-19. This review aims to present a concise overview of the latest findings on rehabilitation and highlight emerging trends for patients undergoing ECMO support. METHODS This integrative review was conducted by searching the National Library of Medicine - PubMed database. Two different search strings "extracorporeal membrane oxygenation" AND "rehabilitation" and "extracorporeal membrane oxygenation" AND "physiotherapy" were used to search the published literature. Articles that did not describe rehabilitation techniques, editorials, conference proceedings, letters to editor, reviews and research protocols were excluded. Studies conducted on pediatric populations were also excluded. The search process was completed in December 2023. RESULTS Thirteen articles were included in the final analysis. Eight hundred and thirty-nine patients aged between 27 and 63 years were included; 428 were men (51%). In 31% of the included studies, patients had COVID-19; nevertheless, rehabilitative activities did not differ from non-COVID-19 patients. In most studies, rehabilitation commenced within the first 48-96 h and consisted of progressive exercise and out-of-bed activities such as sitting, standing and walking. CONCLUSION Current practice focuses on rehabilitative protocols that incorporate exercise routines with progressive intensity, greater emphasis on out-of-bed activities, and a multidisciplinary approach to patient mobilization.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
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Shkurka E, Child H, Balls J, Melkhuln E, Carter L, Compton V, Marscheider R, McConnell R, Meenaghan S, Milburn N, Nugent G, Peabody G, Rimmer L. Early rehabilitation and mobilisation of neonatal and paediatric extracorporeal membrane oxygenation patients: A UK and Ireland consensus document. Perfusion 2024; 39:174-181. [PMID: 36240012 DOI: 10.1177/02676591221132676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite increasing early rehabilitation and mobilisation (ERM) in paediatric intensive care, current evidence for ERM of neonatal and paediatric patients receiving extracorporeal membrane oxygenation (ECMO) is limited. The proposed benefits of ERM in neonatal and paediatric ECMO patients are multifaceted, including reduced immobility related issues and maintenance of functional ability. However, ECMO presents additional safety and logistical challenges, and currently there are no published neonatal or paediatric guidelines. A consensus document was developed to provide guidance for ERM with neonatal and paediatric ECMO patients. The document was developed by specialist physiotherapists from nine ECMO centres within the UK and Ireland, together with the UK Paediatric Critical Care Society ECMO group and members of the multidisciplinary team. The document covers key considerations and practicalities for completing ERM in this population including, acuity level measurement, activity level guidance, safety and risk assessment, and goal setting. Risk assessment and safety checklist bedside tools are also included and designed to be adapted as required to meet specific unit policies and protocols.
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Affiliation(s)
- Emma Shkurka
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hannah Child
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Jennie Balls
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Ellie Melkhuln
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lee Carter
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Rachel McConnell
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Natalie Milburn
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Gemma Peabody
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laura Rimmer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Polastri M, Eden A, Loforte A, Dell'Amore A, Antonini MV, Riera J, Barrett NA, Swol J. Physiotherapy for patients on extracorporeal membrane oxygenation support: How, When, and Who. An international EuroELSO survey. Perfusion 2024; 39:162-173. [PMID: 36239077 DOI: 10.1177/02676591221133657] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Extracorporeal membrane oxygenation (ECMO) continues to play an essential role in organ support in cardiogenic shock or acute respiratory distress syndrome and bridging to transplantation. The main purpose of the present survey was to define which clinical and organizational practices are adopted for the administration of physiotherapy in adult patients undergoing ECMO support worldwide. METHODS This international survey was conceived in November 2021. The survey launch was announced at the 10th EuroELSO (European ELSO chapter) Congress, London, May 2022. RESULTS The survey returned 32 questionnaires from 29 centers across 14 countries. 17 centers (53.1%) had more than 30 intensive care unit beds available and most (46.8%) were able to care for five to 10 patients on extracorporeal life support simultaneously. The predominant physiotherapist-to-patient ratio was 1:>5 (37.5%); physiotherapy was available 5/7 days and 7/7 days by 31.2% and 25% respectively. Respiratory physiotherapy was not defined by a specific protocol in most centers (46.8%) while 31.2% declared that the treatment commences less than 12 h after sedation is stopped/reduced. Mostly, early physiotherapy in non-cooperative ventilated patients was provided within the first 48 h (68.6%) and consisted of as passive range of motion, in-bed positioning, and splinting. Postural passages and sitting were provided to patients and walking was included in those advanced motor activities which are part of the treatment. CONCLUSION Physiotherapy in patients on ECLS is feasible, however substantial variability exists between centers with a trend of delivering not protocolized and understaffed rehabilitation practices.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Antonio Loforte
- Department of Cardiac-Thoracic-Vascular Diseases, Cardiac Surgery and Transplantation, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Dell'Amore
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Division of Thoracic Surgery, University of Padua, Padua, Italy
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Jordi Riera
- Critical Care Department, Vall D´Hebron Research Institute, Barcelona, Spain
| | - Nicholas A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
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Chatziefstratiou AA, Fotos NV, Giakoumidakis K, Brokalaki H. The Early Mobilization of Patients on Extracorporeal Membrane Oxygenation: A Systematic Review. NURSING REPORTS 2023; 13:751-764. [PMID: 37218947 DOI: 10.3390/nursrep13020066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/24/2023] Open
Abstract
Patients on extracorporeal membrane oxygenation (ECMO) often require prolonged periods of bed rest owing to the severity of their illness. Care is also required to maintain the position and integrity of the ECMO cannula. However, they experience a range of effects due to prolonged bed rest. This systematic review examined the possible effects of the early mobilization in patients on ECMO. The database PUBMED was searched by using appropriate keywords: "rehabilitation", "mobilization", "ECMO" and "extracorporeal membrane oxygenation". The selection criteria for the article search were the following: (a) studies published in the last five years, (b) descriptive studies, (c) randomized studies, (d) published in the English language and (e) studies in adults. A total of 259 studies were found, 8 of which were finally selected. Most of the studies showed that early intensive physical rehabilitation related to a decrease in in-hospital stay and a reduction in the duration of mechanical ventilation and doses of vasopressors. In addition, improvements in the functional status and rate of mortality were observed along with a reduction in health care costs. Exercise training should be a fundamental part of the management of patients on ECMO.
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Affiliation(s)
| | - Nikolaos V Fotos
- Department of Nursing, National and Kapodistrian University of Athens, 15771 Athens, Greece
| | - Konstantinos Giakoumidakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Hero Brokalaki
- Department of Nursing, National and Kapodistrian University of Athens, 15771 Athens, Greece
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Braune S, Warnke K, Kluge S. [Active mobilization during extracorporeal membrane oxygenation-safety first]. Med Klin Intensivmed Notfmed 2023; 118:317-318. [PMID: 36944858 DOI: 10.1007/s00063-023-01000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Stephan Braune
- IV. Med. Klinik: Akut‑, Notfall- und Intensivmedizin, St. Franziskus-Hospital Münster, Hohenzollernring 70, Münster, Deutschland.
| | - Katja Warnke
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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8
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Cucchi M, Mariani S, De Piero ME, Ravaux JM, Kawczynski MJ, Di Mauro M, Shkurka E, Hoskote A, Lorusso R. Awake extracorporeal life support and physiotherapy in adult patients: A systematic review of the literature. Perfusion 2022:2676591221096078. [PMID: 35760523 DOI: 10.1177/02676591221096078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The Awake Extracorporeal Life Support (ECLS) practice combined with physiotherapy is increasing. However, available evidence for this approach is limited, with unclear indications on timing, management, and protocols. This review summarizes available literature regarding Awake ECLS and physiotherapy application rates, practices, and outcomes in adults, providing indications for future investigations. METHODS Four databases were screened from inception to February 2021, for studies reporting adult Awake ECLS with/without physiotherapy. Primary outcome was hospital discharge survival, followed by Extracorporeal Membrane Oxygenation (ECMO) duration, extubation, Intensive Care Unit stay. RESULTS Twenty-nine observational studies and one randomized study were selected, including 1,157 patients (males n = 611/691, 88.4%) undergoing Awake ECLS. Support type was reported in 1,089 patients: Veno-Arterial ECMO (V-A = 39.6%), Veno-Venous ECMO (V-V = 56.8%), other ECLS (3.6%). Exclusive upper body cannulation and femoral cannulation were applied in 31% versus 69% reported cases (n = 931). Extubation was successful in 63.5% (n = 522/822) patients during ECLS. Physiotherapy details were given for 676 patients: exercises confined in bed for 47.9% (n = 324) patients, mobilization until standing in 9.3% (n = 63) cases, ambulation performed in 42.7% (n = 289) patients. Femoral cannulation, extubation and V-A ECMO were mostly correlated to complications. Hospital discharge survival observed in 70.8% (n = 789/1114). CONCLUSION Awake ECLS strategy associated with physiotherapy is performed regardless of cannulation approach. Ambulation, as main objective, is achieved in almost half the population examined. Prospective studies are needed to evaluate safety and efficacy of physiotherapy during Awake ECLS, and suitable patient selection. Guidelines are required to identify appropriate assessment/evaluation tools for Awake ECLS patients monitoring.
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Affiliation(s)
- Marta Cucchi
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Maria E De Piero
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Michal J Kawczynski
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Emma Shkurka
- Cardiac Intensive Care Unit, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aparna Hoskote
- Cardiac Intensive Care Unit, 4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, and Cardiology Department, Heart and Vascular Center, 199236Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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Kawauchi A, Liu K, Nakamura M, Suzuki H, Fujizuka K, Nakano M. Risk Factors for Bleeding Complications during Venovenous Extracorporeal Membrane Oxygenation as a Bridge to Recovery. Artif Organs 2022; 46:1901-1911. [PMID: 35451086 PMCID: PMC9543801 DOI: 10.1111/aor.14267] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/17/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Abstract
Background Bleeding complications during venovenous extracorporeal membrane oxygenation (V‐V ECMO) can be critical. However, there is limited information on the associated risk factors. This study investigated the risk factors for bleeding complications during V‐V ECMO as a bridge to recovery. Methods This single‐center retrospective study enrolled 59 patients (bleeding and non‐bleeding groups) who received V‐V ECMO from 2012 to 2020, to evaluate whether peak activated partial thromboplastin time (APTT) value, lowest platelet count, and mobilization to sitting on the edge of the bed during V‐V ECMO were risk factors for bleeding complications, defined according to the Extracorporeal Life Support Organization guidelines. Age, sex, body mass index, Sequential Organ Failure Assessment score, and ECMO duration before bleeding complications were covariates in the multivariate logistic regression analysis. Results Thirty‐one (53%) participants experienced 36 bleeding complications; the ECMO cannulation site, gastrointestinal tract, and nasopharyngeal region were the most common bleeding sites. The use of transfusion products and length of ECMO and intensive care unit stay were significantly and medical costs were non‐significantly increased in the bleeding group. Peak APTT (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.05, p < 0.01) was significantly associated whereas the lowest platelet count (OR 0.96, 95% CI 0.82–1.13, p = 0.66) was unassociated with bleeding complications during ECMO. Achieving mobilization (OR 0.14, 95% CI 0.02–1.17, p = 0.07) decreased the trend of risk for bleeding complications. Conclusions Peak APTT might be an independent modifiable factor for bleeding complications during V‐V ECMO. The protective effect of mobilization during V‐V ECMO requires further investigation.
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Affiliation(s)
- Akira Kawauchi
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles hospital, Brisbane, Australia
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Hiroyuki Suzuki
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Minoru Nakano
- Advanced Medical Emergency Department & Critical Care Center, Japanese Red Cross Maebashi Hospital, Gunma, Japan
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Rehabilitation of adult patients on extracorporeal membrane oxygenation: A scoping review. Aust Crit Care 2021; 35:575-582. [PMID: 34711492 DOI: 10.1016/j.aucc.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The objective of this study was to conduct a scoping review to comprehensively map the breadth of literature related to the rehabilitation of adult patients whilst on extracorporeal membrane oxygenation (ECMO) and identify gaps and areas for future research. REVIEW METHOD USED This review was conducted using recommended frameworks for methods and reporting including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATE SOURCES We searched seven databases from inception to June 2021 and included all study designs and grey literature. REVIEW METHODS Eligibility screening was completed by two independent reviewers according to inclusion and exclusion criteria, with any disagreement resolved by consensus or with consultation with a third reviewer. Two independent reviewers extracted data related to intervention characteristics, patient outcomes, feasibility, safety, hospital outcomes, and mortality using a custom-designed piloted form. RESULTS Of 8507 records, 185 original studies met inclusion criteria, with the majority being small retrospective studies. Rehabilitation was more commonly reported in patients on veno-venous rather than veno-arterial ECMO. Ambulation was the most commonly reported intervention (51% of studies). Critical gaps were identified including incomplete reporting of the intervention along with heterogeneity in the type and timing of outcome measures. Less than 50% of patients met eligibility criteria to participate, but screening for eligibility was infrequently reported (9% of studies). Delivery of rehabilitation during ECMO may be facilitated by an expert multidisciplinary team, along with a strategy that targets low sedation levels and an upper body cannulation approach. CONCLUSIONS Rehabilitation during ECMO is an emerging area of research and mostly consisted of small retrospective single-centre studies. Future research requires more robust methodological designs that include comprehensive screening of potential candidates with reporting of eligibility, more detailed descriptions of the rehabilitation interventions, inclusion of a core outcome set with defined measurement instruments, and consistent timing of outcome measurement.
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Scarpino M, Bonizzoli M, Lazzeri C, Lanzo G, Lolli F, Ciapetti M, Hakiki B, Grippo A, Peris A, Ammannati A, Baldanzi F, Bastianelli M, Bighellini A, Boccardi C, Carrai R, Cassardo A, Cossu C, Gabbanini S, Ielapi C, Martinelli C, Masi G, Mei C, Troiano S. Electrodiagnostic findings in patients with non-COVID-19- and COVID-19-related acute respiratory distress syndrome. Acta Neurol Scand 2021; 144:161-169. [PMID: 33890282 PMCID: PMC8250908 DOI: 10.1111/ane.13433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Critical illness polyneuropathy and myopathy (CIPNM) is a frequent neurological manifestation in patients with acute respiratory distress syndrome (ARDS) from coronavirus disease 2019 (COVID-19) infection. CIPNM diagnosis is usually limited to clinical evaluation. We compared patients with ARDS from COVID-19 and other aetiologies, in whom a neurophysiological evaluation for the detection of CIPNM was performed. The aim was to determine if there were any differences between these two groups in frequency of CINPM and outcome at discharge from the intensive care unit (ICU). MATERIALS AND METHODS This was a single-centre retrospective study performed on mechanically ventilated patients consecutively admitted (January 2016-June 2020) to the ICU of Careggi Hospital, Florence, Italy, with ARDS of different aetiologies. Neurophysiological evaluation was performed on patients with stable ventilation parameters, but marked widespread hyposthenia (Medical Research Council score <48). Creatine phosphokinase (CPK), lactic dehydrogenase (LDH) and mean morning glycaemic values were collected. RESULTS From a total of 148 patients, 23 with COVID-19 infection and 21 with ARDS due to other aetiologies, underwent electroneurography/electromyography (ENG/EMG) recording. Incidence of CIPNM was similar in the two groups, 65% (15 of 23) in COVID-19 patients and 71% (15 of 21) in patients affected by ARDS of other aetiologies. At ICU discharge, subjects with CIPNM more frequently required ventilatory support, regardless the aetiology of ARDS. CONCLUSION ENG/EMG represents a useful tool in the identification of the neuromuscular causes underlying ventilator wean failure and patient stratification. A high incidence of CIPNM, with a similar percentage, has been observed in ARDS patients of all aetiologies.
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Affiliation(s)
- Maenia Scarpino
- Neurophysiopathology UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
- IRCCS Don Carlo GnocchiFlorenceItaly
| | - Manuela Bonizzoli
- Traumatic Intensive Care UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
| | - Chiara Lazzeri
- Traumatic Intensive Care UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
| | - Giovanni Lanzo
- Neurophysiopathology UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
| | - Francesco Lolli
- Biomedical Science Department Mario SerioUniversity of FlorenceFlorenceItaly
| | - Marco Ciapetti
- Traumatic Intensive Care UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
| | | | - Antonello Grippo
- Neurophysiopathology UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
- IRCCS Don Carlo GnocchiFlorenceItaly
| | - Adriano Peris
- Traumatic Intensive Care UnitNeuromuscolar Department ‐ AOU CareggiFlorenceItaly
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2019. Critical care. Minerva Anestesiol 2020; 86:102-113. [PMID: 31994860 DOI: 10.23736/s0375-9393.20.14384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, ASST - Spedali Civili Children's Hospital, Brescia, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Department of Accident and Emergency, of Organ Transplantation, Anesthesia and Intensive Care, Siena University Hospital, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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Braune S, Bojes P, Mecklenburg A, Angriman F, Soeffker G, Warnke K, Westermann D, Blankenberg S, Kubik M, Reichenspurner H, Kluge S. Feasibility, safety, and resource utilisation of active mobilisation of patients on extracorporeal life support: a prospective observational study. Ann Intensive Care 2020; 10:161. [PMID: 33259044 PMCID: PMC7708587 DOI: 10.1186/s13613-020-00776-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background There is scarce evidence on the feasibility, safety and resource utilisation of active mobilisation in critically ill patients on extracorporeal life support (ECLS). Methods This prospective observational single-centre study included all consecutive critically ill patients on ECLS admitted to an academic centre in Germany over a time period of one year. The level of mobilisation was categorised according to the ICU Mobility Scale (IMS). Primary outcome was complications during mobilisation. Results During the study period, active mobilisation with an activity level on the IMS of ≥ 3 was performed at least on one occasion in 43 out of 115 patients (37.4%). A total of 332 mobilisations with IMS ≥ 3 were performed during 1242 ECLS days (26.7%). ECLS configurations applied were va-ECMO (n = 63), vv-ECMO (n = 26), vv-ECCO2R (n = 12), av-ECCO2R (n = 10), and RVAD (n = 4). Femoral cannulation had been in place in 108 patients (93.9%). The median duration of all mobilisation activities with IMS ≥ 3 was 130 min (IQR 44–215). All mobilisations were undertaken by a multi-professional ECLS team with a median number of 3 team members involved (IQR 3–4). Bleeding from cannulation site requiring transfusion and/or surgery occurred in 6.9% of actively mobilised patients and in 15.3% of non-mobilised patients. During one mobilisation episode, accidental femoral cannula displacement occurred with immediate and effective recannulation. Sedation was the major reason for non-mobilisation. Conclusions Active mobilisation (IMS ≥ 3) of ECLS patients undertaken by an experienced multi-professional team was feasible, and complications were infrequent and managed successfully. Larger prospective multicentre studies are needed to further evaluate early goal directed sedation and mobilisation bundles in patients on ECLS.
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Affiliation(s)
- Stephan Braune
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Patrick Bojes
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anne Mecklenburg
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Federico Angriman
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gerold Soeffker
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Katja Warnke
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Dirk Westermann
- Department of Interventional and General Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Interventional and General Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Mathias Kubik
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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