Ambulation in Veno-Arterial-Venous (VAV) Cannulation for ECMO Support in COVID-19 Related ARDS with Right Ventricular Failure

PURPOSE: Physical functioning in patients undergoing extracorporeal membrane oxygenation (ECMO) related to strict bedrest requirements is debilitating. Physical therapy (PT) in these patients can be beneficial. However, the data in COVID-19 associated with acute respiratory distress syndrome (ARDS) is not well characterized. We present our experience with ambulation in patients receiving veno-arterial-venous (VAV) ECMO support. METHODS: Clinical charts of COVID-19 associated ARDS patients with VAV-ECMO support who received PT sessions between January 2021 and October 2021 were retrospectively reviewed and analyzed. Mobility functions were assessed. Episodes of oxygen saturation and hypotension were noted as primary outcomes. RESULTS: Eight patients were placed on VAV-ECMO for decompensated heart failure with right axillary artery cannulation via vascular graft and right internal jugular vein double lumen (Avalon) cannula. Mean age was 46.9 ± 10.3 years, and BMI was 30.6 ± 4.4 kg/m(2) with five males. Mean duration of ECMO support was 53.6 ± 13.4 days. Average PT sessions per patient were 22.8 ± 12.2, with average days to PT initiation from ECMO insertion being 19.0 ± 8.1 days. The total average time per daily PT session was 27.2 ± 9.3 minutes. The ability to perform mobility functions with minimal, moderate, total, stand-by, contact-guard assistance for all patients is listed in the table. During PT sessions, a total of 14 episodes of oxygen desaturation and six episodes of hypotension in four patients were noted. There were no events of any cannula displacement. Of all, three are still in the hospital supported by ECMO, three transferred to the lung transplant center, one died in hospital, and one discharged home. CONCLUSION: VAV ECMO support via right axillary and RIJ dual lumen cannulation provides a safe strategy for prolonging support and effective rehabilitation in severe COVID-19 related ARDS patients complicated with RV failure.