title: Physical rehabilitation of patients in the intensive care unit requiring extracorporeal membrane oxygenation: a small case series.
abstract: OBJECTIVE
  Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients.
  
  
  METHODS
  This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues.
  
  
  RESULTS
  In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients.
  
  
  CONCLUSIONS
  Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.
authors.affiliation: Department of Medicine and Outcomes After Critical Illness and Surgery, OACIS, Research Group, Johns Hopkins University, Baltimore, Maryland 21205, USA.
authors.forename: Rod A
authors.initials: RA
authors.lastname: Rahimi
authors.forename: Julie
authors.initials: J
authors.lastname: Skrzat
authors.forename: Dereddi Raja S
authors.initials: DR
authors.lastname: Reddy
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zanni
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.forename: R Scott
authors.initials: RS
authors.lastname: Stephens
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003550:Cystic Fibrosis / Q000150:complications; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016040:Lung Transplantation; D008223:Lymphoma / Q000150:complications; D008297:Male; D018908:Muscle Weakness / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011014:Pneumonia / Q000150:complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000534:rehabilitation*