Contemporary Phase I Cardiac Rehabilitation: A Case Report of Pre- and Post-Heart Transplant

Patients in cardiac intensive care units (ICUs) often require mechanical circulatory support (MCS) devices. Phase I cardiac rehabilitation for patients requiring a single MCS device appears safe and feasible. However, the simultaneous use of multiple MCS devices is relatively new and rehabilitation practices have had less evaluation in these circumstances. This case report describes phase I cardiac rehabilitation delivery in a 73-year-old man with cardiogenic shock supported with simultaneous femoral-femoral, veno-arterial extracorporeal membrane oxygenation and percutaneous ventricular assist device, commonly referred to as ECPella. The patient participated in structured rehabilitation before and after heart transplantation, including during ECPella support. Rehabilitation sessions during ECPella support were tolerated well with no adverse events. The patient's functional mobility improved from completely dependent for all mobility to independent with ambulation and activities of daily living by discharge from acute comprehensive inpatient rehabilitation unit. This case describes the individualized approach to delivering phase I cardiac rehabilitation in a patient with a complicated hospital course requiring multiple MCS devices and a heart transplant. Additionally, it suggests the implementation of rehabilitation interventions when a patient is supported by multiple MCS devices appears to be safe and feasible via an interdisciplinary approach.