WVU Medicine physical therapist setting the pace in rehabilitation care for patients on ECMO

MORGANTOWN, W.Va. – Kari DiVito, P.T., D.P.T., physical therapist in the Rehabilitation Services Department at WVU Medicine-WVU Hospitals, has written a mobility guideline that speaks to the interdisciplinary efforts of physical and occupational therapists, nurses, and the ECMO team to assist patients with a return to normal daily function.   

“While early mobility is not necessarily a new concept in the world of acute care rehabilitation, the challenges associated with patients on ECMO definitely add a level of complexity to their care which can impede functional recovery,” Bruce L. McKee, M.S., C.C.C./S.L.P., director of Rehabilitation Services, said. “Kari has worked diligently with her fellow team members to raise the bar and provide treatment teams with proven strategies to progress patients towards positive outcomes.”  

ECMO (extra-corporeal membrane oxygenation) is a life-support machine used in patients with life-threatening heart and/or breathing problems. When the heart does not pump enough blood or the lungs do not provide enough oxygen, ECMO can be used to assist the heart and/or lungs while giving the body a chance to rest.

Dr. DiVito, a board-certified clinical specialist in cardiovascular and pulmonary physical therapy, has been the Department’s go-to physical therapist during the COVID-19 pandemic.

During her time with the ECMO team, DiVito created several research initiatives regarding mobility of this medically complex patient population. She has had the opportunity to present her findings on national and international stages in both rehabilitation and medical venues. During these presentations, many in attendance asked how she did it. 

DiVito encountered a lack of literature regarding the rehabilitation of the patient on ECMO, and that published literature to date is typically limited to a case study or case series only. Currently, there are no published mobility guidelines for this population. In fact, older literature recommended that rehabilitation efforts only begin after patients were removed from the ECMO machine. 

During the pandemic, the ECMO program at WVU Medicine J.W. Ruby Memorial Hospital had the highest published survival rate in the country, and DiVito was involved with rehabilitation efforts for most of those patients while they were on ECMO. In addition, the ECMO program is the only one of its kind in the state was recognized nationally with an ELSO Gold Center of Excellence Life Support Award from the Extracorporeal Life Support Organization (ELSO), which recognizes those centers that demonstrate an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction, and ongoing clinical care.

DiVito’s mobility guideline, titled, “Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring ECMO,” will be published in the Cardiopulmonary Journal of Physical Therapy this year and will serve to fill a gap in the current literature base as well as to forge best practice in the standard of care for the patient on ECMO.