日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

There are few reports on early physiotherapy for critically ill pediatric patients and extracorporeal membrane oxygenation in Japan due to concerns about medical device removal by accident. We present a safe method of early physiotherapy during extracorporeal membrane oxygenation with neck cannulation, as well as the treatment plan. The patient was a 2-year-old boy weighing 14.3 kg with no medical history. He had symptoms of tachypnea and severe tachycardia, so tachycardia-induced cardiomyopathy was diagnosed. On the 2nd day of hospitalization, the heart failure worsened, resulting in low cardiac output syndrome and requiring extracorporeal membrane oxygenation. Physiotherapy, which included range of motion exercises, respiratory physiotherapy, and postural drainage, began on the same day as extracorporeal membrane oxygenation; it was ensured that the neck cannulation insertion angle, drainage pressure, and blood flow were not changed using a handmade wedged-shape urethane cushion. Extracorporeal membrane oxygenation was removed on the 4th day of hospitalization, and there were no complications during the initial physiotherapy. The patient was extubated on the 11th day of hospitalization and discharged on the 14th hospitalization day. Early physiotherapy during extracorporeal membrane oxygenation could be performed safely in a pediatric patient with acute or severe heart failure by ensuring the neck cannulation insertion angle and neck position.