Early Mobilization for a Patient With a Right Ventricular Assist Device With an Oxygenator

Abstract

Background: Physical therapists and occupational therapists safely provide early mobilization (EM) to patients requiring mechanical circulatory support (MCS). Limited EM studies are available on patients with a right ventricular assist device with an oxygenator (Oxy-RVAD). Purpose: The case report describes the EM course and functional outcomes of EM for a patient with Oxy-RVAD with central cannulation in the intensive care unit (ICU). Case Description: A 40-year-old man was admitted for a spontaneous pneumothorax. His hospital course included acute deep vein thrombosis and pulmonary embolism with worsening of interstitial lung disease and cardiomyopathy, requiring emergent pulmonary thromboendarterectomy and subsequent Oxy-RVAD. A multidisciplinary team initiated EM 3 days after cannulation. Outcomes: The patient safely participated in 6 EM sessions, which included both physical therapy and occupational therapy, over 10 days on MCS with no major adverse events. Clinically meaningful improvements were noted on the ICU Mobility Scale score (3 points) and the John Hopkins Highest Level of Mobility (1 point). The patient received a heart-lung transplant on the 11th day of Oxy-RVAD support. Discussion: EM for patients on MCS with central cannulation, including those on Oxy-RVAD, is safe and feasible and can result in clinically significant functional gains. A framework for clinical decision-making regarding EM eligibility is presented.