Acute Care Rehabilitation of the Cardiac Patient and Patients Requiring Advanced Mechanical Circulatory Support and ECMO

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Course Description

Rehabilitation therapy for patients in complex acute care and intensive care units is a growing area of practice for physical and occupational therapists. Improved medical and surgical interventions have allowed for patients to be supported in the ICU for longer periods of time, resulting in high rates of ICU-Acquired Weakness.

Rehabilitation therapy for patients requiring cardiac surgery is a long-standing as well as rapidly growing area of practice for physical and occupational therapists across the continuum of care. As medical device technology and surgical techniques improve, and the number of and acuity of patients grows, rehabilitation therapists are going to have increased responsibility for caring for these patients. This growing population has unique rehabilitation needs, especially as patients who are more critically ill are able to receive these life-saving therapies, but have the impact of multiple surgeries, long length of stay, and longevity of illness. Rehabilitation professionals who treat in acute care should be aware of the considerations for patients who have coronary artery disease, cardiac muscle dysfunction, and heart failure and are either in preparation for or have received surgical intervention.

Early mobility and intervention by physical and occupational therapists is paramount to improve the medical and physical outcomes of patients in the ICU. The speaker will review relevant medical and surgical devices, oxygen delivery devices, pharmacology, lab values, sedation considerations, and potential challenges that therapists may be faced with while working with the acute care and ICU patient population and provide tools to advocate for improved mobility practice. Time will be spent focusing on advanced areas of practice including mechanical ventilation, advanced mechanical circulatory support, and Extracorporeal Membrane Oxygenation (ECMO).

Extracorporeal Membrane Oxygenation (ECMO) is a lifesaving intervention for patients suffering from respiratory and cardiac insufficiency. While safe mobilization of patients on ECMO support has been documented, evidence-based guidelines for ECMO rehabilitation remain sparse. Initiating, maintaining, and progressing ECMO mobility with patients can be difficult, especially if physical therapists and other ICU staff have limited experience.

Experiences will be shared regarding gaining physician, nursing, and respiratory therapy buy-in, up-training therapy staff, and progressing patient mobility with interdisciplinary care to optimize mobility in acute and critical care environments. Case studies will be reviewed and patient outcomes discussed to provide examples of rehabilitation interventions to progress beyond “early mobility” with lessons and considerations for PTs and OTs in all areas of practice.

Course Objectives

At the end of this course, the participant will be able to:

• Describe the etiology and pathology resulting in coronary artery disease, cardiac muscle dysfunction and heart failure in order to better understand the patient presentation.
• Describe general considerations for mobilizing patients on advanced monitoring, advanced oxygen support, and mechanical circulatory support including safety with the support system as well as ICU environmental considerations for the cardiopulmonary patient.
• Integrate the foundational physiology of pharmacology, medical/surgical interventions, advanced oxygen support and mechanical ventilation, MCS and ECMO and the underlying patient disease process with the principles of exercise and rehabilitation.
• Describe the ideal team and role delineation for safely mobilizing and rehabilitating a mechanically ventilated patient and review patient case examples.

Course Agenda:

8:00               Introduction/Cardiac pathophysiology

• • • Heart failure
    • Coronary artery disease
    • Valve dysfunction
    • Arrhythmias

9:00               Medical management of cardiac patients

• • • Pharmacology
    • Non-surgical and minimally invasive cardiac interventions

9:45                Surgical management of cardiac patients

10:30              Break

10:45               Introduction to the ICU

• • • Lines, Tubes, and Monitors
      • Ventilators and advanced oxygen delivery
      • Invasive lines
      • Monitoring equipment
    • Safety/Feasibility data

11:15               Introduction to MCS/ECMO

• • • Medical diagnoses that result in MCS Support/ECMO cannulation
    • Considerations and prognosis in patients requiring MCS/ECMO support
    • Types of MCS and ECMO support (VV, VA), physiology and function of MCS/ECMO
    • Cannulation strategies – location of cannulas and considerations
    • Sedation protocols and indications/considerations for initiating and weaning
    • Mechanical ventilation/oxygen delivery in conjunction with ECMO
    • Vital signs, diagnostic trends and the relative stability of the ECMO patient
    • Indications for consulting rehabilitation therapy

11:45              Lunch

12:45             Rehabilitation management in cardiac non-surgical patients

• • • Medications
    • Impact of mobility
    • Vital signs and safety
    • Best practice literature
    • Rehab interventions

1:30              Rehabilitation management in cardiac surgical patients

• • • Medications and surgical precautions
    • Impact of mobility
    • Vital signs and safety
    • Best practice literature
    • Rehab interventions

2:15              Break

2:30             Rehabilitation management in MCS and ECMO patients

• • • Vital sign and ABG monitoring for exercise titration
    • ECMO support goals – weaning versus continued support/Lung Transplantation
    • Maximizing functional and medical outcomes
    • Rehabilitation “beyond walking”
    • Defining “stability”
    • Medical considerations for best practice (meds: benzos, anti-anxiety, sedation, pre-oxygenation, timing of procedures (bronchs), weaning of support or ventilation timing)
    • Palliative care and ethical considerations, “Hard lessons”
    • Family and psychosocial considerations

3:30               Case Discussions and Q&A

4:30               End

Other Course Information:

• Course check-in begins at 7:30am

• Prerequisites

  None

• Educational Level

  Intermediate