title: Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support.
abstract: The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited.
  
  
  METHODS
  Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency. Physiotherapy staff in the Center has regular work hours and night duties, so can provide round-the clock rehabilitation treatment adjusted to the dynamically changing clinical picture of the patient.
  
  
  RESULTS
  We analyzed the group of patients who were treated in our center from July 2013 to March 2015. The degree of functional complications increased with the duration and extent of hypothermia and time of conducting extracorporeal therapy. The frequent problems were: respiratory failure due to sputum retention (25%) or sternum fracture due to resuscitation (25%), lower and upper extremity muscle weakening (75%), peroneal nerve palsy (25%). In the first period of hospitalization all of patients have generalised edema. As a result of the treatment and rehabilitation, full stabilization of the cardiovascular - respiratory system and full recovery of neurological functions was achieved in 14 persons (73.68%).
  
  
  CONCLUSIONS
  early and round-the clock physiotherapy treatment adequate to appearing patient's syndromes seems crucial for his physical and mental recovery after severe accidental hypothermia treated by ECMO support. In order to attain therapeutic success, it is indispensable to work in experienced, multidisciplinary team.
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland; Academy of Physical Education, Cracow, Poland.
authors.forename: Dominika
authors.initials: D
authors.lastname: Batycka-Stachnik
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Piwoda
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland, e-mail: tomekdarocha@wp.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Darocha
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Spiewak
authors.affiliation: Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane , Poland; Tatra Mountain Rescue Service, Zakopane, Poland.
authors.forename: Sylweriusz
authors.initials: S
authors.lastname: Kosinski
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Jarosz
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Hubert
authors.initials: H
authors.lastname: Hymczak
authors.affiliation: Department of Disaster Medicine and Emergency Care, Medical College of Jagiellonian University, Krakow, Poland; Department of Combat Medicine, Military Institute in Warsaw.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Sanak
authors.affiliation: Department of Emergency Medical Services, Medical University of Warsaw, Polish Medical Air Rescue, Warsaw, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Galazkowski
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Piatek
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Konstanty-Kalandyk
authors.affiliation: Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
authors.forename: Rafal
authors.initials: R
authors.lastname: Drwila
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000150:complications / Q000534:rehabilitation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: extracorporeal membrane oxygenation; hypothermia; rehabilitation / physiotherapy; rewarming