Recovery of skeletal muscle strength and physical function in a patient with (post) COVID-19 requiring extra-corporeal membrane oxygenation

Figures & data

Figure 1. Ambulation with support of a multidisciplinary team while on ECMO.

The ECMO specialist (depicted on the right) monitors ECMO parameters and security of the cannulas during exercise, while the physical therapist (depicted on the left) focusses on providing support during walking and monitoring of fatigue and safety issues concerning walking ability. An ICU nurse follows (not depicted) with a chair and monitors security of the lines at the back.

Table 1. Clinical course of physical function recovery milestones.

ICU Phase		Physical therapy intervention
Phase A: Day 1–41	MV (P-CMV and SPONT), V–V ECMO	PROM
		Prevention of contractures
Phase B: Day 42–65	MV (SPONT, P-CMV and APV (volume targeted)), High Flow during weaning, V–V ECMO	In-bed positioning
		In-bed cycling
		Out of bed in-chair (passive transfer)
		Passive standing (tilt)
		Active standing
		Active transfer bed-chair
		In-chair exercises
		Ambulation (~2-10 m) with mobility aid and 2 persons
Phase B: Day 66	MV (SPONT), High Flow during weaning, V–V ECMO decannulation	In chair exercises
Phase B: Day 67	High Flow	Ambulation (2x 10 m) with mobility aid and 1 person
		In-chair exercises
Phase B: Day 68	standard oxygen therapy (1 L) nasal canula	Airway Clearance Techniques
Phase B: Day 69 ICU discharge	Weaning from standard oxygen therapy in rest, 2 L add O2 during exercise	Ambulation (~10 meters) with mobility aid and 1 person
		In-chair exercises

APV = Adaptive Pressure Ventilation; ECMO = extracorporeal membrane oxygenation; MV = mechanical ventilation; P-CMV = pressure supported continuous mandatory ventilation; Phase A: patient is unconscious; Phase B: patient is conscious and able to cooperate; PROM = passive range of motion; SPONT = pressure supported spontaneous breathing; V–V ECMO = veno-venous ECMO

Figure 2. Skeletal muscle strength and physical function parameters recovery.

The dotted horizontal line shows the cutoff value for ICUAW on the MRC sum-score; Vertical dotted lines indicate the dates when the patient started out-bed chair positioning (A), standing (B) and walking (C)