Early Mobility for Antepartum Post VA-ECMO Patient with Non-Traumatic Spinal Cord Injury: A Case Report

Abstract

<h3>Research Objectives</h3> To describe mobility progression of a post VA-ECMO non-traumatic spinal cord injured patient immediately antepartum with prolonged hospitalization. <h3>Design</h3> Cardiac arrest represents approximately 56.6% of complications in the immediate antepartum period where extracorporeal membrane oxygenation (ECMO)is indicated. ECMO cannulations include veno-arterial (VA), veno-venous (VV), and venous-arterial-venous (VAV), where large-bore catheters are placed into large vessels and connected to a circuit. A membrane oxygenator pumps blood to exchange oxygen and carbon dioxide. Spinal cord tumors develop inside the spinal canal and are intramedullary or extramedullary. They can impact motor and sensory neurons, triggering pain, loss of movement, sensory changes, and bowel and bladder dysfunction. Dichorionic diamniotic gestation occurs when each fetus has a separate placenta and amniotic sac. Mothers remain at increased risk of premature labor and delivery. <h3>Setting</h3> 746 bed university affiliated tertiary hospital. <h3>Participants</h3> 31-year-old Dominican obese female with spinal cord tumor at 25 weeks 5 days gestation with dichorionic diamniotic pregnancy. Placed on VA-ECMO following cardiac arrest secondary to massive pulmonary embolism. <h3>Interventions</h3> Physical therapy (PT) initiated in the intensive care unit (ICU) following VA-ECMO decannulation. Interventions included cognitive stimulation, positioning, bed mobility, strengthening, cycle ergometry, and out of bed tolerance. Sessions were 15-60 minutes and progressed following standard safety measures. <h3>Main Outcome Measures</h3> FSS-ICU, AM-PAC, and RASS scores; manual muscle strength; number of therapy sessions; and mechanical ventilation (MV) days. <h3>Results</h3> PTs collected data in the hospital-based setting. Patient demonstrated improvement on outcome measures, although statistical significance was not calculated. FSS-ICU from un-scorable to 8/35, AM-PAC from 6/24 to 7/24, RASS score from -5 to 0, manual muscle strength from 0/5 throughout to 3+/5 to 4-/5 in the upper extremities and 0/5 in the lower extremities by discharge. 15 total PT sessions, including 13 in the ICU. 5 mobility sessions while on MV. <h3>Conclusions</h3> PT was deemed safe, and patient demonstrated improved functional mobility . Additional research is warranted for this population, although this case may serve as a framework given lack of complex patients to compare protocols to. <h3>Author(s) Disclosures</h3> No disclosures.