P0237 / #1004: PHYSICAL REHABILITATION DURING VA ECMO WITH CENTRAL CANNULATION AS A BRIDGE TO LUNG TRANSPLANT IN AN INFANT

Abstract

Aims & Objectives: Introduction: Pulmonary veno-occlusive disease (PVOD) is a rare pediatric disorder with a grim prognosis requiring lung transplantation for survival. Veno-Arterial Extracorporeal membrane oxygenation (VA-ECMO) support can be utilized as a bridge to transplantation, but with prolonged use of this strategy can be associated with severe deconditioning due to the need for neuromuscular blockade and long-term sedation for circuit integrity in infants. Methods: Case Report Results: We report a case of an 8-month-old male transferred to our pediatric critical care unit for pulmonary hypertension management in the setting of right ventricular dysfunction. He was found to have severe PVOD requiring extracorporeal life support as a bridge to lung transplantation. He was cannulated onto peripheral VA ECMO. Due to prolonged peripheral VA ECMO and difficulties with rehabilitation, the patient was transitioned to central cannulation with placement of Berlin cannulas in the pulmonary artery and ascending aorta. After this, his sedation was weaned and he was able to participate in physical therapy. Post-transplant, he had musculoskeletal weakness impacting his gross motor skills and functional mobility. He has received intensive physical and occupational outpatient therapy and continues to demonstrate progression. At 14-months-old, he is able to walk a few steps, grasp objects, and his truncal tone continues to improve. Conclusions: Conclusion: Central cannulation with Berlin cannulas is a novel approach that has not been described in the literature as a bridge to transplant in pediatrics. This modality allows patients to receive physical therapy while on VA ECMO with minimal risk of cannula displacement.