(340) Physical Rehabilitation in Patients Requiring Extended Advanced Mechanical Circulatory Support

Introduction: Early mobilization can reduce ICU length of stay (LOS) and improve functional outcomes for patients with complex medical conditions. Physical therapy (PT) intervention for patients requiring extended durations of mechanical circulatory support (MCS) and extra-corporeal membrane oxygenation (ECMO) has been demonstrated to be both feasible and safe. Authors sought to explore differences in functional outcome measures for patients requiring MCS/ECMO who participated in PT while on support versus patients who did not.

Methods: A retrospective, single-center review aimed to evaluate functional, clinical, and longitudinal outcomes in critically ill adults who underwent physical therapy intervention while receiving MCS/ECMO through advanced configurations including venovenous (VV-ECMO), venoarterial (VA-ECMO), oxygenator with right ventricular assist device (Oxy-RVAD) and right ventricular assist device (RVAD). Clinical data included number and intensity of physical therapy sessions, functional outcomes, and discharge disposition.

Results: Sixty five patients (73.8% male, 50.7% white) were included between January and December of 2021. Within this population, MCS cannulation strategies were as follows: 32 VA, 32 VV, 1 Oxi-RVAD. Twenty six percent (n= 17) received PT while on MCS (MCS PT), thirty seven percent (n=24) received PT after decannulation (Post-MCS PT). The remaining thirty seven percent (n=24) did not receive PT (No PT). ICU LOS was significantly longer in the MCS PT group (59.9 days) than the Post-MCS PT (23.8 days) and no PT groups (8.87 days) (p < 0.05). Days on MCS were significantly longer in the MCS PT group (47.0 days) than the Post-MCS PT (8.33 days) and No PT groups (7.57 days) (p < 0.05). Of the 24 patients in the No PT group, seventy nine percent (n=19) expired while on MCS. Function at first PT and last PT visit measured by AM-PAC 6-Clicks Basic Mobility Score did not show significant difference between the MCS PT and No-MCS PT groups, despite significantly longer LOS in ICU.

Conclusions: For patients that require prolonged MCS, function can be preserved through active rehabilitation interventions despite medical complexity and longer length of stay. As rehabilitation while on MCS has been shown to be safe, earlier referral could provide further potential benefit.