title: Safety of Nurse-Led Ambulation for Patients on Venovenous Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Venovenous extracorporeal membrane oxygenation (VV ECMO) is an effective therapy in patients with acute lung injury and end-stage lung disease. Although immobility increases the risk of complications, ambulation of patients on VV ECMO is not the standard of care in many institutions. Staff concerns for patient safety remain a barrier to ambulation. In this case series, we present our experience utilizing a nurse-driven ambulatory VV ECMO process to safely rehabilitate patients.
  
  
  METHODS
  We retrospectively reviewed all VV ECMO cases at our institution between January 1, 2011, and November 1, 2013. Inclusion criteria for this study required patients to be cannulated in the right internal jugular vein and ambulated while on VV ECMO.
  
  
  RESULTS
  During the period from January 1, 2011, to November 1, 2013, 18 patients (mean age 49 ± 15 years, 12 male) were ambulated while on ECMO. Eight received a transplant and survived to discharge. Of the remaining patients, 4 were successfully weaned from VV ECMO and 6 died following decisions by the family to withdraw care. The mean duration of VV ECMO support was 18 ± 16 days with the maximum duration being 61 days. All patients received physical therapy, range of motion at the bedside, and ambulated in the hospital. There were no patient falls, decannulations, or any other complications related to ambulation.
  
  
  CONCLUSIONS
  The adoption of a nurse-driven program to ambulate patients on VV ECMO is safe and may reduce other complications associated with immobility.
authors.affiliation: Cardiovascular Intensive Care Unit, University of Kentucky, KY, USA bryanboling@uky.edu.
authors.forename: Bryan
authors.initials: B
authors.lastname: Boling
authors.affiliation: Transplant Center, University of Kentucky, KY, USA.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Dennis
authors.affiliation: Gill Heart Institute, University of Kentucky, KY, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Tribble
authors.affiliation: Division of Cardiovascular Medicine, University of Kentucky, KY, USA.
authors.forename: Navin
authors.initials: N
authors.lastname: Rajagopalan
authors.affiliation: Department of Surgery, Section of Thoracic Transplantation, University of Alabama, Birmingham, AL, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Hoopes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000379:methods*; D061214:Patient Safety; D026741:Physical Therapy Modalities; D012131:Respiratory Insufficiency / Q000451:nursing / Q000534:rehabilitation*; D012189:Retrospective Studies; D016138:Walking
keywords: ECMO; ambulation; nursing; safety