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A case study on early progressive mobilization and physical therapy management in a patient status post total artificial heart device implantation.

(1) Fernandez, Natalia M.; (1) Ford, Kimberly. (1) Physical Medicine and Rehabilitation, University of Michigan, Health System, Ann Arbor, MI, United States.

Background & Purpose: Research shows that early mobilization of critically ill patients is safe, effective in shortening length of stay and improving outcomes. Physical Therapists (PTs) are involved in early mobilization of these patients and recent research shows that PTs mobilize them to higher levels than nursing. Cardiectomy in total artificial heart (TAH) patients prevents electrocar-diography, telemetry, and native pulse rate monitoring. Cardiac intensive care unit care following TAH surgery is particularly specialized and requires monitoring of nontraditional vital signs. Since limited guidance regarding Physical Therapy (PT) management is available in this unique case, we describe our experience with early mobilization of a patient (pt) following TAH surgery. Case Description: A 49 y/o male was admitted for LVAD vs transplant evaluation. Patient medical history/ comorbidities included nonischemic dilated systolic heart failure, pulmonary hypertension, unstable angina, atrial fibrillation, ICD, hypertension, obstructive sleep apnea, dermal mycosis, gout, and osteoarthritis. Patient hospital course was complicated with multiple episodes of VTACH, torsades requiring tandem heart placement. TAH surgery was performed using a CardioWest Total Artificial Heart on day 21 of admission. PT initial assessment and education was initiated post operative day (POD) 2. Patient achieved 75% bed in chair position limited by pain, POD 3. There was multidisciplinary approach to subsequent PT sessions with participation of the nurse, perfusionist, 2 PTs, and a technician. Patient completed transfer to recliner with moderate assistance of 2, POD 4. By end of week 1 pt performed sit to stand with minimal/moderate assistance of 2 from recliner and ambulated 180 feet with 2 standing rest breaks with contact guard assistance of 2 using upper extremity support on TAH console. As the pt progressed, treatments were completed with a PT and nurse. By the end of week 2, pt completed transfers with moderate to stand by assistance, standing/exercise for 25-30 minutes and ambulated 335 feet with contact guard to minimal assistance without an assistive device, with 4 standing rest breaks. Patient received a heart transplant on POD 15. Outcomes: Published information on recovery following implantation of the CardioWest TAH, states that 75% of patients receiving the implant according to protocol were out of bed within the first week and by the end of two weeks, 60.5% were able to walk more than 100 feet. The patient in this case study progressed significantly faster, getting out of bed on POD 4, walking greater than 150 feet within the first week and greater than 300 feet by the second week. Discussion: We believe that early progressive mobilization by a multidisciplinary team with the PT directing care in this case was well tolerated, without significant complication and with improved outcomes than is typically expected following TAH implantation.
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Publication:Cardiopulmonary Physical Therapy Journal
Date:Dec 1, 2011
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