49: “From 278 Days on V-V ECMO to Recovery: A Physiotherapy Management in a Case of Protracted ARDS Management”

Introduction: Few publications describe the recovery of patients from long runs on extracorporeal membrane oxygenation (ECMO), though they present risks of ICU-acquired weakness and immobility-related consequences that impair rehabilitation and recovery. Case Presentation: A 41-year-old woman was admitted to another hospital with influenza causing adult respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) and proning, and underwent Caesarean section to deliver a healthy daughter. She decompensated and required veno-venous ECMO support for 26 days before transfer to the authors’ institution for possible lung transplantation (LTx). After 113 days, she was listed for LTx. Complications over the course of care included severe hypoxic respiratory failure, recurrent right pneumothorax, bronchopleural fistula, critical illness neuropathy, and renal failure. Physical therapy (PT) evaluation was completed one day after admission. The patient demonstrated 1/5 strength in selected upper and lower limb muscles, and a passive transfer to chair was achieved. PT interventions commenced, with a goal of a PT session on every weekday. Interventions included progressive mobility guided by published protocols. She remained on V-V ECMO for 278 days, with provision of 154 PT sessions and 15 deferred sessions. 92 sessions were done with femoral-jugular configuration, and 62 with dual lumen jugular cannula. Mobility level achieved each day was recorded by ICU Mobility Scale, showing a trajectory of recovery (Table 1). 112 (72.7%) included ambulation, up to 280 meters. The patient was weaned from ECMO and MV, no longer required LTx, and was discharged to rehabilitation after 366 days. Discussion: No previous case has described such a prolonged ECMO course with continuous rehabilitation involvement. Intensive rehabilitation led to meaningful recovery and favorable discharge outcomes. Exercises and mobility interventions may have contributed to minimizing complications, promoting ventilator weaning, and avoiding transplantation. Conclusion: This case demonstrates the importance of a robust PT service integrated into ECMO programs.