Background: Femoral cannulated extracorporeal membrane oxygenation (ECMO) has been associated with neurologic complications in the lower extremity ipsilateral to the cannulation. There is uncertainty about the prevalence of these complications and their mechanisms of development. Objective: Aim of this systematic review was to investigate the prevalence of neurological complications after ECMO and to describe possible underlying mechanisms. Method: A systematic literature search was performed in Medline-Ovid, Embase, Cochrane Library, CINAHL, and PEDro until April 2021 for clinical trials in English or German language which quantified neurologic complications in the lower extremity ipsilateral to the ECMO cannulation of adults. The complications had to be delimitable to intensive care unit–acquired weakness. Methodological quality was assessed by 2 independent investigators using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute. Results: Eight observational studies were included in the synthesis. Study quality was good to fair in 88% of the papers. Overall, 47 of 202 patients (23.3%; ranging from 3% to 48% across studies) with femoral ECMO cannulation showed neurologic complications of the lower extremity ipsilateral to the cannulation. Peripheral ischemia and compression of nerves by the ECMO cannula are discussed as mechanisms of injury. Conclusion: The occurrence of neurological complications after ECMO was common and can lead to long-term impairment. The mechanisms are largely unknown but currently there is no sufficient evidence for the involvement of ECMO. Standardized assessments are needed to systematically screen for neurological complications early after ECMO, to enable countermeasures and prevent further complications.

Background: Central facial palsy (CFP) is a common condition following stroke, typically affecting the lower face and causing symptoms such as drooling, dysarthria, and facial asymmetry. Despite available rehabilitation methods, the evidence supporting their effectiveness is limited. Electromyography (EMG)-triggered Functional Electrical Stimulation (FES) has shown promise in neurorehabilitation for motor impairments, but its application to CFP remains unclear. Methods: This case report explores the use of EMG-triggered FES in a 77-year-old patient with CFP following a severe ischemic stroke of the middle cerebral artery (MCA). Therapy, focused on stimulating the orbicularis oris muscle to address persistent drooling and improve facial symmetry, was alongside usual care. The stimulation duration was 5–15 min, frequency 35 Hz, and pulse duration 300 µs, applied 5 times a week. Stimulation duration was adjusted based on the patient’s progress. Results: The patient underwent 16 sessions of EMG-triggered FES over four weeks. Post-therapy reassessment with the Sunnybrook Facial Grading System (SFGS) showed an improvement in facial motor function, with the score increasing from 58/100 to 78/100. Reassessment of the Facial Disability Index (FDI) revealed significant improvement in physical function (55 to 85 points), though the social function score slightly decreased (76 to 64 points). Improvements in dysarthria and the complete resolution of drooling were reflected in the physical function domain of the FDI and the Allensbach Dysarthria Severity Scale. Conclusions: The results highlight that EMG-triggered FES was well tolerated and effectively supported therapy, contributing to the resolution of drooling, improved facial symmetry, and enhanced speech function. Future research should focus on randomized controlled trials to confirm its effectiveness and determine optimal therapy parameters.

Das Trachealkanülen-Management bei Patient*innen mit Intensive-Care-Unit-acquired Weakness (ICU-AW) ist anspruchsvoll und erfordert ein komplexes multidisziplinäres Vorgehen. Durch die ICU-AW sind durch muskuläre Schwäche oft Atmung und Schlucken beeinträchtigt, und das Weaning ist prolongiert. Spezialisierte Therapieansätze fördern die Dekanülierung, minimieren das Aspirationsrisiko und unterstützen das Wiedererlangen von Alltagsfunktionen. Tracheostomy management in critically ill patients with intensive care unit-acquired weakness is complex and requires a multidisciplinary approach. ICU-AW often leads to muscular weakness, impairing breathing and swallowing and resulting in prolonged weaning. Specialized therapeutic interventions promote decannulation, minimize the risk of aspiration, and support the recovery of activities of daily living. Article published online: 03 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Inspiratory muscle training (IMT) could improve outcomes, but implementation in clinical practice is poor, with patients at high risk often being excluded in trials. The aim of this study was to assess feasibility and safety of implementing standardised IMT in critically ill adults with a tracheostomy. A prospective, single-centre observational study was performed in a tertiary, mixed intensive care unit (ICU) using a standardised IMT protocol with a threshold device. IMT was performed with two sets of six repetitions at ≥30% of maximal inspiratory pressure (MIP) or ≥9 cmH₂O. Primary outcome was feasibility and safety of IMT using a priori defined criteria. Secondary outcomes included a descriptive analysis of functional changes from IMT initiation to ICU discharge. From January to July 2019, 57 patients (age: 62 ± 14 years, 35% female) were eligible for IMT, of whom 31 (54%) were tracheostomised due to weaning failure, 19 (33%) with reduced consciousness and seven (12%) with dysphagia. Fifty-one patients passed safety screening, of whom 42 (82%) completed at least one IMT session. A total of 160 of 203 (79%) sessions were attempted and 152 (75%) performed with a median of three sessions per patient. IMT was terminated in eight (5%) sessions due to a priori defined intolerance reaction: minimal resistance too high (3 [38%]), respiratory rate >35 breaths/min (2 [25%]), patient refusal (1 [13%]), increase of blood pressure (1 [13%]), and agitation (1 [13%]) without further consequences. There were no adverse events. The median difference from IMT initiation to ICU discharge of MIP was 6 cmH₂O (95% confidence interval: 3.5 to 10.5). MIP was moderately correlated with the ability to follow commands (r = 0.395). IMT was feasible and safe in critically ill patients with a tracheostomy, including those who could not follow commands. Although MIP improved during the ICU stay, no causal relationship to IMT can be inferred. Future randomised controlled trials should be performed to explore outcomes in this under-researched population.