title: Active rehabilitation during extracorporeal membrane oxygenation as a bridge to lung transplantation.
abstract: BACKGROUND
  Patients with end-stage lung disease often progress to critical illness, which dramatically reduces their chance of survival following lung transplantation. Pre-transplant deconditioning has a significant impact on outcomes for all lung transplant patients, and is likely a major contributor to increased mortality in critically ill lung transplant recipients. The aim of this report is to describe a series of patients bridged to lung transplant with extracorporeal membrane oxygenation (ECMO) and to examine the potential impact of active rehabilitation and ambulation during pre-transplant ECMO.
  
  
  METHODS
  This retrospective case series reviews all patients bridged to lung transplantation with ECMO at a single tertiary care lung transplant center. Pre-transplant ECMO patients receiving active rehabilitation and ambulation were compared to those patients who were bridged with ECMO but did not receive pre-transplant rehabilitation.
  
  
  RESULTS
  Nine consecutive subjects between April 2007 and May 2012 were identified for inclusion. One-year survival for all subjects was 100%, with one subject alive at 4 months post-transplant. The 5 subjects participating in pre-transplant rehabilitation had shorter mean post-transplant mechanical ventilation (4 d vs 34 d, P = .01), ICU stay (11 d vs 45 d, P = .01), and hospital stay (26 d vs 80 d, P = .01). No subject who participated in active rehabilitation had post-transplant myopathy, compared to 3 of 4 subjects who did not participate in pre-transplant rehabilitation on ECMO.
  
  
  CONCLUSIONS
  Bridging selected critically ill patients to transplant with ECMO is a viable treatment option, and active participation in physical therapy, including ambulation, may provide a more rapid post-transplantation recovery. This innovative strategy requires further study to fully evaluate potential benefits and risks.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina 27710, USA. kyle.rehder@duke.edu
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: W Lee
authors.initials: WL
authors.lastname: Williford
authors.forename: Desiree
authors.initials: D
authors.lastname: Bonadonna
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Walczak
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.forename: David
authors.initials: D
authors.lastname: Zaas
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000293:Adolescent; D000328:Adult; D016638:Critical Illness; D015199:Extracorporeal Membrane Oxygenation / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult