Venovenous (VV) extracorporeal membrane oxygenation (ECMO) supports end-organ oxygen delivery in patients with refractory respiratory failure. Physical therapy (PT) while on ECMO provides conceptual benefits of strength and conditioning. Physical therapy can additionally be used to facilitate improvements in functional status of pulmonary reserve while VV ECMO is used to bridge to lung transplant or recovery. We report the case of a patient initially supported with VV ECMO that due to a course complicated by refractory hypoxia, cardiac arrest, and cardiogenic shock, was successfully supported with parallel, independent VV ECMO circuits, allowing for ongoing PT, to bridge to lung transplant, decannulation, and hospital discharge.
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) can support patients with isolated respiratory failure as a bridge to recovery or transplant.1 Percutaneous peripheral cannulation is preferred over central access due to invasiveness, although some limitations exist, including refractory hypoxia. Increasing the delivery of oxygen and reducing oxygen extraction are management goals for refractory hypoxia in VV ECMO.2 Patients with respiratory disease can develop right ventricular (RV) failure which could result in cardiogenic shock and refractory hypoxia ultimately requiring right ventricular device (RVAD) or venoarterial (VA) ECMO.3 Refractory hypoxia can significantly limit physical therapy (PT) and mobilization which are integral parts of both bridging to recovery and transplantation. The addition of a parallel ECMO circuit may increase physiologic support for oxygenation, allowing patients to continue to engage with PT, improve functional mobility, and participate in strengthening before transplantation.4,5 We report an interesting case of a patient supported with VV ECMO who developed refractory hypoxia after cardiac arrest and was supported with parallel VV ECMO circuits. This allowed him to participate in PT and maintain his strength before being successfully bridged to lung transplantation. The patient provided informed verbal and written consent.