Adoption of the prone position in extracorporeal membrane oxygenation: a case series
DOI:
https://doi.org/10.18471/rbe.v38.56061Keywords:
Intensive Care Units, COVID-19, Severe Acute Respiratory Syndrome, Prone Position, Extracorporeal Membrane OxygenationAbstract
Objective: to describe the experience of the prone position in patients undergoing ECMO to manage refractory hypoxemia due to COVID-19, highlighting complications and the evolution of ventilatory parameters after positioning. Method: retrospective analysis of medical records between March/2020 and January/2022. Seven male patients with a mean age of 57.7 years underwent the interventions, the main comorbidities found were cardiovascular and metabolic diseases. Results: after positioning, ECMO weaning was successful and the association proved to be effective in recruiting posterior lung regions, amplifying the viable region for gas exchange, with the main complication observed being the development of skin lesions. Conclusion: the positioning, in the experience of the center, was positive and effective in the management of refractory hypoxemia and hypercapnia. No serious or potentially fatal complications were observed, demonstrating the importance of a trained team and well-designed protocols for the safety of interventions.
Downloads
References
Tonna JE, Abrams D, Brodie D, Greenwood JC, Mateo-Sidron JAR, Usman A, et al. Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J. 2021; 67(6): 601-610. DOI: 10.1097/MAT.0000000000001432
Badulak J, Antonini MV, Stead CM, Shekerdemian L, Raman L, Paden ML, et al. Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J. 2021; 67(5): 485-495. DOI: 10.1097/MAT.0000000000001422
Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, et al; Extracorporeal Life Support Organization: Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020; 396(10257): 1071-1078. DOI: 10.1016/S0140-6736(20)32008-0
Guérin C, Reignier J, Richard JC, Beuret P, Gacoiun A, Boulain T et al. Prone positioning in Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2013; 368(23): 2159-2168. DOI: 10.1056/NEJMoa1214103
Guérin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med. 2020; 46: 2385-2396. DOI: 10.1007/s00134-020-06306-w
Roca O, Pacheco A, García-de-Acilu. To prone or not to prone ARDS patients on ECMO. Crit Care. 2021; 25(315). DOI: 10.1186/s13054-021-03675-6
Giani M, Martucci G, Madotto F, Belliato M, Fanelli V, Garofalo E. Prone positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: a multicenter cohort study and propensity-matched analysis. Ann Am Thorac Soc. 2021; 18(3): 495-501. DOI: 10.1513/AnnalsATS.202006-625OC
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evidence-Based Medicine. 2018; 23(2): 60-63. DOI: 10.1136/bmjebm-2017-110853
Harrison SL, Buckley BJR, Rivera-Caravaca JM, Zhang J, Lip GYH. Cardiovascular risk factors, cardiovascular disease, and COVID-19: an umbrella review of systematic reviews. Eur Heart J Qual Care Clin Outcomes. 2021; 7(4): 330-339. DOI: 10.1093/ehjqcco/qcab029
Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, et al. Predicting survival after extracorporel membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 2014; 189(11): 1374-1382. DOI: 10.1164/rccm.201311- 2023OC
Moore Z, Patton D, Avsar P, McEvoy NL, Curley G, Budri A et al. Prevention of pressure ulcers among individuals cared for in the prone position: lessons for the COVID-19 emergency. J Wound Care. 2020; 29(6): 312-320. DOI: 10.12968/jowc.2020.29.6.312
Oliveira AC, Garcia PC, Nogueira LS. Nursing workload and occurrence of adverse events in intensive care: a systematic review. Rev Esc Enferm USP. 2016; 50(4): 679-689. DOI: 10.1590/S0080-623420160000500020
Downloads
Published
How to Cite
Issue
Section
License
COPYRIGHT STATEMENT TEMPLATE
NURSING SCHOOL
POSTGRADUATE PROGRAM IN NURSING
UNIVERSIDADE FEDERAL DA BAHIA
To Editorial Coordination
Revista Baiana de Enfermagem
ANNUITY LETTER FOR PUBLICATION, TRANSFER OF COPYRIGHT AND STATEMENT OF LIABILITY
We declare that, in case of acceptance of the manuscript _____________________________, we agree to the transfer of all copyrights to the Revista Baiana de Enfermagem, any reproduction, total or partial, in any other part or means of disclosure, printed or electronic, without the authorization, prior and necessary, is requested and, if obtained, we will record the competent thanks to the Revista Baiana de Enfermagem.
Declaration of responsibility
-“I certify that I participated sufficiently in the authorship of the manuscript to make public my responsibility for the content.”
- "I certify that the manuscript represents an original work and that neither this manuscript, in part or in full, nor any other work with the substantially similar content of my own, published or being considered for publication in another journal, printed or electronic format.”
- “I take full responsibility for the citations and references used in the text, as well as on the ethical aspects that surround the study subjects.”
- “I certify that, if requested, I will provide or cooperate in obtaining and providing data on which the manuscript is based, for examination by the editors.”
Signature of the authors:
____________________________________
____________________________________
____________________________________
[The City], _____[Date]________.
