Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support

Dominika Batycka-Stachnik; Agnieszka Piwoda; Tomasz Darocha; Malgorzata Spiewak; Sylweriusz Kosinski; Anna Jarosz; Hubert Hymczak; Tomasz Sanak; Robert Galazkowski; Jacek Piatek; Janusz Konstanty-Kalandyk; Rafal Drwila

Problems and challenges in the early period of rehabilitating patients with severe hypothermia treated using ecmo support

Wiad Lek. 2016;69(3 pt 2):489-494.

Affiliations

¹ Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland; Academy of Physical Education, Cracow, Poland.
² Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.
³ Department of Anesthesiology and Intensive Care, the John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland, e-mail: tomekdarocha@wp.pl.
⁴ Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane , Poland; Tatra Mountain Rescue Service, Zakopane, Poland.
⁵ Department of Disaster Medicine and Emergency Care, Medical College of Jagiellonian University, Krakow, Poland; Department of Combat Medicine, Military Institute in Warsaw.
⁶ Department of Emergency Medical Services, Medical University of Warsaw, Polish Medical Air Rescue, Warsaw, Poland.
⁷ Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, Medical College of Jagiellonian University, Cracow, Poland.

PMID: 28478412

Abstract

The objectives: To show and discuss the most frequent functional problems encountered in patients who underwent extracorporeal membrane oxygenation (ECMO) treatment after severe hypothermia and point out appropriate physiotherapy procedures used in order to diminish the effects of hypothermia on the human organism. It is necessary to look for effective physiotherapeutic solutions, especially that the number of scientific publications on the subject is very limited.

Design: Retrospective analysis Setting: Severe Accidental Hypothermia Center ( medical intensive care unit of a university hospital) Patients or participants: Nineteen patients who were qualified for ECMO in Severe Accidental Hypothermia Center Intervention: At least three times a day rehabilitation session (physiotherapeutic procedures adequate to patient problems) and interventions in case of emergency. Physiotherapy staff in the Center has regular work hours and night duties, so can provide round-the clock rehabilitation treatment adjusted to the dynamically changing clinical picture of the patient.

Methods and results: We analyzed the group of patients who were treated in our center from July 2013 to March 2015. The degree of functional complications increased with the duration and extent of hypothermia and time of conducting extracorporeal therapy. The frequent problems were: respiratory failure due to sputum retention (25%) or sternum fracture due to resuscitation (25%), lower and upper extremity muscle weakening (75%), peroneal nerve palsy (25%). In the first period of hospitalization all of patients have generalised edema. As a result of the treatment and rehabilitation, full stabilization of the cardiovascular - respiratory system and full recovery of neurological functions was achieved in 14 persons (73.68%).

Conclusion: early and round-the clock physiotherapy treatment adequate to appearing patient's syndromes seems crucial for his physical and mental recovery after severe accidental hypothermia treated by ECMO support. In order to attain therapeutic success, it is indispensable to work in experienced, multidisciplinary team.

Keywords: extracorporeal membrane oxygenation; hypothermia; rehabilitation / physiotherapy; rewarming.

MeSH terms

Extracorporeal Membrane Oxygenation*
Hospitalization
Humans
Hypothermia / therapy*
Respiratory Insufficiency*
Retrospective Studies
Treatment Outcome