Resources for the Physical Therapist

Physical Therapy (PT) is considered a vital part of patient recovery during critical illness. Intensive care physical therapists are trained to assist in optimizing the functions of the musculoskeletal and cardiorespiratory systems through early mobilization, exercise and specialized physical therapy techniques. The evidence is growing to support the use of early rehabilitation in the critically ill including those on mechanical ventilation and extracorporeal life support (ECLS). PT in the ICU has been demonstrated to be safe and feasible. It has been shown to reduce the incidence of neuromuscular weakness and physical deterioration.

To fulfill our role, physical therapists have extensive knowledge on body systems and exercise physiology as well as expert manual handling skills to assist moving more debilitated and complex patients. We ensure that our practice is both safe and evidence based. As a result, the importance of mobilizing even the sickest of our patients to maintain or improve strength and mobility is considered a high priority. For ECLS patients these efforts require a multi-disciplinary approach. As a physical therapist for an ECMO patient, it is your responsibility to understand the basics of ECMO (which can be found on this site).

Special considerations for the Physical Therapist to take when caring for an ECMO patient are: 

When mobilizing an ECLS patient for the first time, consider taking the following approach:

A.    Team Huddle: Talk with the primary nurse and discuss the stability of the patient, the plan for the day, what has transpired throughout the last 24 hours, the patient’s mental status, any concerns the nurse may have, and any precautions that should be noted. Set up a time with the primary nurse that will include their assistance, as well as any assistance needed from the respiratory therapist, lift team, or other care team members. 
B.    Confirm the Mobility Goal: Confirm what the goal is for the day with the appropriate members of the care team. Some medical centers may require a physicians order for the mobility goal, ensure this is up to date. 
C.     Discuss the plan and goal with the patient. Clear communication is not only helpful but essential in helping the patient and family understand the importance of physical therapy and progress. 
D.    Assign multi-disciplinary team roles when physical therapy starts. For example, the ECMO Specialist may be assigned to securing and holding the cannulas; or watching and assessing the overall patient’s condition throughout the therapy session, monitoring the blood pressure, patient’s flows, oxygenation requirements. The RT will stabilize the airway and ensure oxygenation requirements are met. A person to interact with the patient and assist with lifting and moving. Some centers may require a perfusionist to assist with disconnecting and connecting gas lines. Lift team personnel to push a chair behind the patient as they walk. You will determine all the people and items that you need to and are responsible for collaborating with the primary nurse to ensure the safety of the patient. 
E.     Ensure clear lines of communication and understanding of roles prior to mobilizing. 

Check the stability of the patient on the monitor

  • Blood pressure

  • Oxygen saturation

  • Heart rate

  • ECLS flow, rpm and sweep (the ECMO Specialist or primary nurse will also be responsible for noting these items)

  • Monitor the ECLS venous and arterial pressures (with Cardiohelp pumps) prior to and during mobilization; notify the ECMO Specialist or primary nurse with any changes. 

The Cannula(s)

  • Confirm the access site of the cannula

  • Confirm that the cannula type is safe for mobilization 

  • Confirm that all cannulas are properly secured and the external position is noted and documented prior to and following mobilization

Types of equipment the physical therapist may use

A.    Jordan Frame
B.    Walker
C.     Slide board
D.    Gait belt
E.     Bartan Chair
F.     SARA Steady

Document all interventions, response to interventions, communication with the care team and patient, as well as pre-during-post vital signs. This is a great tool that can be referenced by future physical therapists, as well as all members of the care team.

Follow up the next day

  • Ensure all telemetry and ECLS vital signs remained normal, or what had been normal with the trend, for that patient post treatment

  • Review post treatment tolerance with the ECMO Specialist and primary nurse

  • Assess the patient’s fatigue levels