1304 - Novel Inpatient Application of Blood Flow Restriction Therapy (BFRT) in Case of Critical Illness Myopathy Following Complex Heart Transplant Course

Critical illness myopathy (CIM)

Case Description:

A 41-year-old male experienced prolonged hospitalization following LVAD explant and orthotopic heart transplant complicated by an extended ICU course, multiple infections, ECMO, renal failure requiring hemodialysis, and tracheostomy. He was admitted to inpatient rehabilitation with critical illness myopathy, presenting with profound weakness, nonambulatory status, and complete dependence for mobility. BFRT was initiated 2–3 times per week to the bilateral lower extremities during gait training. Sessions incorporated structured strengthening with bilateral knee extensions using ankle weights and sit-to-stand training under 70% limb occlusion pressure for approximately 20 minutes. Sessions were well tolerated without pain, numbness, or skin compromise. At baseline, he required maximal assistance of two for sit-to-stand. After 6 weeks of BFRT, the patient progressed to ambulating 300 feet with a rolling walker and contact guard assistance with wheelchair follow.

Discussions:

BFRT is an evidence-based technique using FDA-approved pneumatic cuffs on proximal limbs. At ~80% limb occlusion pressure in the lower extremities, BFRT restricts venous return while maintaining arterial inflow. This creates an anaerobic environment that enhances muscle fiber recruitment, promotes hypertrophy, and stimulates growth hormone release to support collagen synthesis. Beyond musculoskeletal benefits, BFRT has been shown to improve exercise tolerance, strength, blood pressure, and quality of life in cardiopulmonary populations. These advantages are especially relevant for post-transplant patients unable to tolerate high-intensity resistance training.

Conclusions:

This case demonstrates the feasibility and safety of BFRT in CIM after complex transplant. Integration into gait and strengthening supported clinically meaningful improvements in ambulation distance and independence. BFRT offers rehabilitation clinicians with a low-load, well-tolerated strategy to address profound weakness, promote early mobility, and enhance recovery in medically fragile patients. Larger controlled studies are needed to establish best practices and to optimize rehabilitation outcomes.