A Few Milliliters of Prevention

Ogbu, Ogbonna C.; Martin, Greg S.; Murphy, David J.

doi:10.1097/ccm.0000000000001234

Cited by 7 publications

(1 citation statement)

References 15 publications

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“…Regardless of disease severity, peak pressures and tidal volumes were lower after arrival to the ECMO center. This may reflect the increased experience of teams operating at an ECMO center and likely contributes to the improved survival of patients when transported to ECMO centers ( 26 ). It would be difficult to perform any additional nuanced analysis of these ventilator settings as ventilator settings were modified in-route in 16% of our transports.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study

Zhang

Nikouline

Riggs

et al. 2023

Critical Care Explorations

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IMPORTANCE: Prone positioning is associated with improved mortality in patients with moderate/severe acute respiratory distress syndrome (ARDS) and has been increasingly used throughout the COVID-19 pandemic. In patients with refractory hypoxemia, transfer to an extracorporeal membrane oxygenation (ECMO) center may improve outcome but may be challenging due to severely compromised gas exchange. Transport of these patients in prone position may be advantageous; however, there is a paucity of data on their outcomes. OBJECTIVES: The primary objective of this retrospective cohort study was to describe the early outcomes of ARDS patients transported in prone position for evaluation at a regional ECMO center. A secondary objective was to examine the safety of their transport in the prone position. DESIGN: Retrospective cohort study. SETTING: This study used patient charts from Ornge and Toronto General Hospital in Ontario, Canada, between February 1, 2020, and November 31, 2021. PARTICIPANTS: Patient with ARDS transported in the prone position for ECMO evaluation to Toronto General Hospital. MAIN OUTCOMES AND MEASURES: Descriptive analysis of patients transported in the prone position and their outcomes. RESULTS: One hundred fifteen patients were included. Seventy-two received ECMO (63%) and 51 died (44%) with ARDS and sepsis as the most common listed causes of death. Patients were transported primarily for COVID-related indications (93%). Few patients required additional analgesia (8%), vasopressors (4%), or experienced clinically relevant desaturation during transport (2%). CONCLUSIONS AND RELEVANCE: This cohort of patients with severe ARDS transported in prone position had outcomes ranging from similar to better compared with existing literature. Prone transport was performed safely with few complications or escalation in treatments. Prone transport to an ECMO center should be regarded as safe and potentially beneficial for patients with ARDS and refractory hypoxemia.

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Section: Discussionmentioning

confidence: 99%