Date Presented 03/22/24
Many patients on extracorporeal life support experience prolonged bedrest and complications associated with immobility. The purpose of this study is to describe the functional status of patients who require ECLS from the ICU setting to 6 months.
Primary Author and Speaker: Brittany Boyer Skaer
Additional Authors and Speakers: Justin Ryckman
Contributing Authors: Amber Stefanski, Elisabeth Martin, Heidi Tymkew, Amanda Ruszkowski
PURPOSE: Extracorporeal life support (ECLS) is a life-saving resuscitation strategy that provides temporary heart and/or lung function support in patients with respiratory and/or cardiac failure. Many of these patients experience prolonged bedrest and complications associated with immobility. The purpose of this observational study is to describe the functional status of patients who require ECLS from ICU to 6 months.
METHOD: Adult patients were included if they required ECLS for ≥3 days. General hospital and OT data were collected during the patient’s hospitalization, then phone calls were completed at 60 days and 6 months. The OT data included: AM-PAC ‘6-Clicks’ Activity Score, Katz Index, Lawton Scale, and the Euro-quality of life-5D-5L survey.
RESULTS: Forty-seven patients were enrolled with the mean age of 53.1±12.8 years and 77% were male. OT was initiated a median of 11 days after the ECLS surgery with 47% of the patients being seen by OT while on ECLS. Patients were seen for a mean of 4.2 visits in the ICU and 5.8 visits on the floor. There was a significant improvement in the 6-clicks Activity Score from the initial score (11.3) to Day 10 (14.8) to Day 30/Hospital Discharge (17.1) (p<0.001). Most patients (57%) were discharged home. During the 60-day visit (n=41) the mean Katz score was 4.9±1.7, the Lawton was 4.8±2.6, and 63% reported no problems performing self-care tasks. These values improved during the 6-Month visit (n=25), Katz 5.8±0.4, Lawton 6.9±1.9 and 86% reported no problems with self-care tasks.
CONCLUSION: Patients who require ECLS during their hospitalization present with impairments in their ability to perform ADLs which improves over time.
IMPACT STATEMENT: OT intervention can be beneficial for patients who require ECLS to help them increase their independence in the performance of ADLs.
References
Le Gall, A., Follin, A., Cholley, B., Mantz, J., Aissaoui, N., & Pirracchio, R. (2018). Veno-arterial-ECMO in the intensive care unit: From technical aspects to clinical practice. Anaesthesia, critical care & pain medicine, 37(3), 259–268. https://doi.org/10.1016/j.accpm.2017.08.007
Tramm, R., Ilic, D., Sheldrake, J., Pellegrino, V., & Hodgson, C. (2017). Recovery, Risks, and Adverse Health Outcomes in Year 1 After Extracorporeal Membrane Oxygenation. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 26(4), 311–319. https://doi.org/10.4037/ajcc2017707
