Early Cardiac Rehabilitation in Awake Veno-Arterial ECMO for Fulminant Myocarditis: A Case Report

Although awake veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been increasingly adopted, reports describing the implementation of early cardiac rehabilitation during awake V-A ECMO support, particularly from a nursing perspective, remain limited. We report the nursing experience of early cardiac rehabilitation in a 38-year-old woman with fulminant myocarditis complicated by cardiogenic shock who was supported with awake V-A ECMO. The patient remained conscious and cooperative throughout ECMO support and achieved adequate hemodynamic stability under ECMO and pharmacological support without requiring mechanical ventilation. Based on comprehensive nursing assessment and multidisciplinary team collaboration, early rehabilitation was initiated on day 3 of ECMO support and progressed in a stepwise manner from passive limb exercises to bedside ambulation. No rehabilitation-related adverse events, including cannula dislodgement, major bleeding, worsening arrhythmia, or hemodynamic deterioration, occurred during the rehabilitation sessions. The patient was successfully weaned from ECMO and achieved full recovery of activities of daily living prior to hospital discharge. This case suggests that, under rigorous nursing assessment, continuous monitoring, and close multidisciplinary collaboration, early cardiac rehabilitation during awake V-A ECMO support may be feasible and safe in carefully selected patients with fulminant myocarditis. This experience may provide practical insights for nursing care in similar clinical settings.