Impact of Cardiopulmonary Rehabilitation on Weaning of Extracorporeal Membrane Oxygenation (CaRe-ECMO): a Prospective Multidisciplinary Randomized Controlled Clinical Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Critical Illness
- Sponsor
- The First Affiliated Hospital with Nanjing Medical University
- Enrollment
- 366
- Locations
- 1
- Primary Endpoint
- Rate of ready for ECMO weaning at CaRe-ECMO Day 7
- Status
- Recruiting
- Last Updated
- 4 years ago
Overview
Brief Summary
Mortality of patients suffering critical illness has been dramatically improved with advanced technological development of extracorporeal membrane oxygenation (ECMO) therapy. However, weaning rate stayed low in a majority of ECMO-supported patients. As one of several options, cardiopulmonary rehabilitation serves as effective intervention in the improvement of cardiovascular and respiratory function in various major critical illness. Nonetheless, its roles in facilitating ECMO weaning has not yet been explored. The purpose of this study is to investigate the effectiveness of cardiopulmonary rehabilitation on rate of ready for weaning in ECMO-supported patients (CaRe-ECMO).
Detailed Description
Studies have documented that rate of mechanical ventilation weaning was improved in patients received early rehabilitation intervention while its effectiveness in ECMO weaning remains unclear. This inspires us to hypothesize that if the medical rationale is based on its assumed benefits on cardiac function and oxygenation, then cardiopulmonary rehabilitation may subsequently contribute to earlier weaning of ECMO. The "CaRe-ECMO" trial is a prospective, multidisciplinary, randomized controlled, parallel group, clinical trial. Cardiopulmonary rehabilitation program which encompasses six evidence-based components:1) positioning; 2) passive range of motion (PROM) training; 3) neuromuscular electronic stimulation (NMES); 4) surface electrical phrenic nerve stimulation (SEPNS); 5) respiratory PNF techniques 6) airway clearance techniques; 366 ECMO-supported patients in department of emergency medicine will be randomized to control and CaRe-ECMO group. CaRe-ECMO group will be treated with usual care, ECMO therapy, and cardiopulmonary rehabilitation program. Usual care normally comprises pharmacotherapy, mechanical ventilation, continuous renal replacement therapy (CRRT), intra-aortic balloon pump (IABP), and specific nursing for ECMO therapy and their original injuries, as appropriate. Control group will be treated with usual care, ECMO therapy. The primary objective of the CaRe-ECMO trial is to investigate the impact of cardiopulmonary rehabilitation combined with usual care on rate of ready for ECMO weaning at CaRe-ECMO Day 7, when compared to usual care alone. Secondary objectives are to evaluate the effects of cardiopulmonary rehabilitation on rate of ECMO weaning, total length of ready for ECMO weaning, total length of ECMO weaning, rate of mechanical ventilation weaning, total length of mechanical ventilation, all-cause mortality, rate of major post-ECMO complications, diaphragmatic thickness and mobility, ECMO Unit length of stay (LOS), total hospital LOS, total cost for hospitalization, cerebral performance category (CPC) index, activity of daily living (ADL), and health related quality of life (HRQoL). The CaRe-ECMO trial is designed to test the hypothesis that early cardiopulmonary rehabilitation can accelerate weaning of ECMO-supported patients. If CaRe-ECMO trial results in superior improvement in primary and secondary outcomes, it will offer an innovative treatment option for ECMO-supported patients.
Investigators
Yu Zheng
Attending doctor
The First Affiliated Hospital with Nanjing Medical University
Eligibility Criteria
Inclusion Criteria
- •Aged 18yr or order 2) Eligible for receiving ECMO (veno-venous \[VV\] or veno-arterial \[VA\]) therapy 3) With mechanical ventilation 4) With stable condition and eligible for cardiopulmonary rehabilitation after 72 hours of ECMO 5) With no contraindications for cardiopulmonary rehabilitation 6) With a life expectancy of more than 3 days 7) Sign informed consent form by the guardian
Exclusion Criteria
- •Pregnant 2) Use ECMO as a bridge to recovery or definitive treatment (e.g. lung transplantation or heart transplantation) 3) Enrolled in another trial previously
Outcomes
Primary Outcomes
Rate of ready for ECMO weaning at CaRe-ECMO Day 7
Time Frame: CaRe-ECMO Day 7
Rate of ready for ECMO weaning will be calculated 7 days after cardiopulmonary rehabilitation delivery
Secondary Outcomes
- Total length of mechanical ventilation(From date of mechanical ventilation initiation until the date of mechanical ventilation weaning, assessed up to CaRe-ECMO Day 90)
- All-cause mortality(CaRe-ECMO Day 7, 14, 30 and 90)
- Rate of mechanical ventilation weaning(CaRe-ECMO Day 7, 14, 30 and 90)
- ECMO Unit length of stay (LOS)(Discharge day (discharge from ECMO Unit), assessed up to CaRe-ECMO Day 90)
- Total length of ready for ECMO weaning(From date of ECMO initiation until the date of ready for ECMO weaning, assessed up to CaRe-ECMO Day 90)
- Rate of ECMO weaning(CaRe-ECMO Day 7, 14, 30 and 90)
- Total length of ECMO weaning(From date of ECMO initiation until the date of ECMO weaning, assessed up to CaRe-ECMO Day 90)
- Cerebral performance category (CPC) index(CaRe-ECMO Day 7, 14, 30, 90 and discharge day (discharge from ECMO Unit), assessed up to CaRe-ECMO Day 90)
- Rate of ready for ECMO weaning(CaRe-ECMO Day 14, 30 and 90)
- Major complications(CaRe-ECMO Day 7, 14, 30 and 90)
- Diaphragmatic thickness and mobility(Every three days, assessed up to CaRe-ECMO Day 90)
- Total cost for hospitalization(Discharge day (discharge from hospital), assessed up to CaRe-ECMO Day 90)
- Total hospital length of stay(Discharge day (discharge from hospital), assessed up to CaRe-ECMO Day 90)
- Activity of daily living (ADL)(CaRe-ECMO Day 7, 14, 30, 90 and discharge day (discharge from ECMO Unit), assessed up to CaRe-ECMO Day 90)
- Health related quality of life (HRQoL)(CaRe-ECMO Day 7, 14, 30, 90 and discharge day (discharge from ECMO Unit), assessed up to CaRe-ECMO Day 90)