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ECMO Physiotherapy Network

Extra-Corporeal Membrane Oxygenation (ECMO) is a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a patient whose oxygenation is inadequate despite conventional mechanical ventilation.

This can be Veno-Arterial ‘VA’ ECMO (supporting the heart and lungs), or Veno-Venous ‘VV’ ECMO (supporting the lungs).  VA ECMO is used in cardiac centres, whereas VV ECMO is only provided in specialist Severe Acute Respiratory Failure (SARF) centres.

Further information on ECMO may be found using the links below:

NICE IPG391 Extracorporeal membrane oxygenation for severe acute respiratory failure in adults

NICE IPG482 Extracorporeal membrane oxygenation (ECMO) for acute heart failure in adults

NHS England

Cochrane Evidence

ECMO and respiratory failure

ECMO has been used as a rescue therapy for severe respiratory failure since the 1970s. Following a major randomised controlled trial (Peek et al, 2006) and the subsequent flu pandemics from 2009 onwards, a dedicated UK Respiratory ECMO service was commissioned by NHS England in 2011.

There are 8 UK centres commissioned to provide adult Respiratory ECMO support are:

Scotland:

  • Aberdeen Royal Infirmary (NHS Grampian)

England: 

  • Wythenshawe Hospital, (University of Manchester NHS Foundation Trust)
  • Glenfield Hospital (University Hospitals of Leicester NHS Foundation Trust)
  • Royal Papworth Hospital NHS Foundation Trust
  • Royal Brompton and Harefield NHS Foundation Trust (Guy’s and St Thomas’ NHS Foundation Trust)
  • St Thomas’ Hospital (Guy’s and St Thomas’ NHS Foundation Trust)
  • Bartholomew’s Hospital (Barts Health NHS Trust)
  • Bristol Royal Infirmary (University Hospitals Bristol NHS Foundation Trust)

Mater Hospital (Dublin) also provides VV ECMO services to the Republic of Ireland.

A network map of referral areas and contact details for each centre within the UK  and Ireland can be found here.

 

ECMO Physiotherapy Network

Physiotherapy leaders from the nine UK and Ireland ECMO centres are members of the ECMO Physiotherapy Network. Biannual meetings take place for peer support, sharing of best practice, and governance activity including audit and research.

Physiotherapists who occasionally encounter ECMO or are treating patients after ECMO treatment are encouraged to contact the group for support and advice.

Physiotherapists provide both rehabilitative and respiratory physiotherapy interventions to patients during and after ECMO support.

You can also follow the ECMO Physiotherapy Network on Twitter @ECMO_physio or email: ukecmophysionetwork@gmail.com

A number of resources have been developed by members of the ECMO Physiotherapy Network available to download using the links below: 

Eden A, Purkiss C, Cork G, et al. In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation – United Kingdom ECMO Physiotherapy Network: A consensus agreement for best practice. Journal of the Intensive Care Society. 2017;18(3):212-220. doi:10.1177/1751143717705801

Presentations form Euro ELSO 2022 

Range of Movement Assessment & Positioning

Assessment and Safety Considerations of Rehabilitation

Manual Techniques and Manual Assisted cough

VHI

MI-E

Pre Lung Transplant Ax and Rx 

 

Links to useful articles: -

Physiotherapy for patients on extracorporeal membrane oxygenation support: How, When and Who. An international EuroELSO survery. Polastri, M., Eden, A., Loforte, A., Dell’Amore, A., Antonini, M., Riera, J., Barrett, N & Swol, J. Perufsion. 2022. DOI: 10.1177/02676591221133657

Outcomes of the NHS England national extracorporeal membrane oxygenation service for adults with respiratory failure; a multicentre observational cohort study. Warren, A., Chiu, Y., Villar, S., Fowles, J. et al. BJA, 2020. 125 (3), 259-266. DOI https://doi.org/10.1016/j.bja.2020.05.065

Extracorporeal membrane oxygenation and rehabilitation in patients with COVID-19: A scoping review.  Polastri, M., Swol, J., Lorforte, A. & Dell’Amore, A. Artifical Organs. 2022. 46:30-39. DOI: 10.1111/aor.14110

How I wean patients from veno-venous extra-corporeal membrane oxygenation. Vasques, F., Romitti, F., Gattinoni, L & Camporota, L. Critical Care. 2019. 23:316. https://doi.org/10.1186/s13054-019-2592-5

https://www.england.nhs.uk/wp-content/uploads/2018/07/Extra-corporeal-membrane-oxygenation-service-for-adults-with-cardiac-failure.pdf

Physiotherapy for Patients on Awake Extracorporeal membrane Oxygenation: A Systematic Review. Polastri, M., Loforte, A., Dell’Amore, A. & Nava S. Physiotherapy Research International. 2015. 21(4), 203-209. https://doi.org/10.1002/pri.1644

Physiotherapy on ECMO: Mobility and beyond. Morris, K. & Osman, L. 2017. Qatar Medical Journal, Volume 2017, Issue 1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings, DOI: https://doi.org/10.5339/qmj.2017.swacelso.58

Early physiotherapy in the clinical course of patients on Veno-Venous Extracorporeal Membrane Oxygenation. Bonizzoli, M., Lazzeri, C., Drago, A., Tadini Boninsegni, L., Donati, M., Di Valvasone, A., Pesenti, A. & Peris, A. European Respiratory Journal 2018 52: PA1415; DOI: 10.1183/13993003.congress-2018.PA1415

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review. Ferreira DDC; Marcolino MAZ; Macagnan FE; Plentz RDM; Kessler A. Revista Brasileira de terapia intensiva; May 2019; vol. 31 (no. 2); p. 227-239 DOI: 10.5935/0103-507X.20190017

Effects of a physiotherapic program in patients on veno-venous extracorporeal membrane oxygenation: an 8-year single-center experience. Bonizzoli M; Lazzeri C; Drago A; Tadini Boninsegni L; Donati M et al. Minerva anestesiologica; Sep 2019; vol. 85 (no. 9); p. 989-994 DOI: 10.23736/S0375-9393.19.13287-7

Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO). Hayes K; Holland AE; Pellegrino VA; Mathur S; Hodgson CL. Journal of critical care; 2018; vol. 48 ; p. 1-8 DOI: 10.1016/j.jcrc.2018.08.002