Clinical Reasoning and Collaboration for Functional Mobility and Ambulation Under Multiple Conditions of Concurrent CentriMag Ventricular Assistive Devices: A Case Report

Abstract

Background: The CentriMag Extracorporeal Blood Pumping System is an effective means of temporary ventricular support for patients acutely decompensating from cardiac shock. Out-of-bed activities are not currently recommended by the manufacturer, leaving patients functionally limited and restricted to the intensive care unit (ICU). Purpose: This report aims to describe progression of functional mobility and ambulation with CentriMag ventricular assist device (VAD) equipment using appropriate clinical reasoning and multidisciplinary collaboration. Methods: Functional mobility activities were initiated on the first physical therapy (PT) session and progressed throughout the length of stay and included sit–stand transfers, bed–chair transfers, standing activities, and ambulation. Outcomes: The patient remained in the cardiovascular surgical ICU for 30 days and received PT for 13 total treatment sessions with 4 different physical therapists without adverse events. Out-of-bed activities were performed during all 13 PT sessions and the average session duration was 49.8 minutes. Ambulation was documented on 9/13 sessions and on the days the patient ambulated, and the average distance was approximately 183 feet. The patient was seen on 7 occasions with biventricular assist device CentriMag devices and 6 occasions with the concurrent CentriMag right VAD–HeartMate II left VAD. Discussion: As the technology and scope of application for VADs continues to progress, it is imperative that the acute care PT understands the complexities, risks, and benefits of functional mobility in critically ill patients. Conclusion: This report suggests that mobilization with CentriMag devices is feasible, without adverse events, using appropriate clinical decision-making, and suggests that patients who ambulate under multiple conditions of CentriMag VADs may demonstrate functional improvements.