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Active Rehabilitation During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation
Nine patients from a single institution underwent ECMO support as a bridge to transplantation with 100% post-transplant one year survival. Five patients underwent a rehabilitation program and had minimal sedation. Four patients underwent standard sedation and were immobilized in bed during the ECMO bridge. Rehabilitation could be conducted only in those patients who were cannulated with a two stage single cannula either in the internal jugular or subclavian vein as those with femoral vein cannula could not be mobilized. Rehabilitation started with active and passive exercises in bed, progressed to sitting, then standing and finally ambulation. This required a multi-person team including one strictly responsible for the ECMO cannula and lines. Those who underwent rehabilitation had shorter: post-transplant mechanical ventilation (4 d vs. 34 d), ICU stay (11 d vs. 45 d) and hospital stay (26 d vs. 80 d). This paper underscores two points: ECMO can be successfully used as a bridge to lung transplantation and pre-transplant deconditioning has a negative impact on the post-transplant outcome.