Prone Position during ECMO is Safe and Improves Oxygenation

Kipping, Valesca; Weber‐Carstens, Steffen; Lojewski, Christian; Feldmann, Paul; Rydlewski, Antje; Boemke, Willehad; Spies, Claudia; Kastrup, Marc; Kaisers, Udo X.; Wernecke, Klaus D.; Deja, Maria

doi:10.5301/ijao.5000254

Cited by 46 publications

(62 citation statements)

References 36 publications

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“…One study reported 11 prone positioning maneuvers, of a total of 74 maneuvers among 12 subjects, resulted in bleeding from the cannula site. 2 In addition, Otterspoor et al 3 reported 1 subject who experienced bleeding from the cannula site; however, the majority of all subjects (94.3%) did not experience this complication. Other documented complications observed while subjects were receiving concurrent ECMO and prone positioning therapy included pneumothorax (2.0%), 10 edema (12.2%), 11 and entrance of air into the ECMO circuit (2.0%).…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…The majority of the subjects experienced no complications from concurrent ECMO and prone positioning therapy. 2,3,6,7,[9][10][11] However, the most common complications included bleeding from the ECMO cannula site. One study reported 11 prone positioning maneuvers, of a total of 74 maneuvers among 12 subjects, resulted in bleeding from the cannula site.…”

Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%

“…4 Adding prone positioning therapy can also help reduce the risk of memory and other cognitive impairments associated with hypoxemia. 2,5 However, severe complications can potentially result from prone positioning ECMO patients. 2,3,[6][7][8][9][10][11] Prone positioning alone can pose serious risks.…”

Section: Introductionmentioning

confidence: 99%

“…1 Extracorporeal membrane oxygenation (ECMO) may be offered to provide the lungs an opportunity to rest and recover. 2 Since the first trial of ECMO in the 1960s, this life support mechanism has transitioned over the years from primarily being used in neonates with cardiac diseases and irregularities to use in adults with a variety of life-threatening conditions, including ARDS. Veno-venous ECMO is primarily used in patients with respiratory failure, where a large-bore cannula is typically inserted into the right internal jugular vein, providing a blood infusion pathway, and a large-bore cannula inserted into the femoral vein provides the drainage pathway.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] The Guidelines for Adult Respiratory Failure from the Extracorporeal Life Support Organization 4 recommend the consideration of adding prone positioning therapy to patients receiving ECMO if there is posterior consolidation of the lung fields with some lung fields open anteriorly. The guidelines recommend exercising caution to prevent the dislodgment of the ECMO cannulas.…”

Section: Introductionmentioning

confidence: 99%

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Complications of Prone Positioning During Extracorporeal Membrane Oxygenation for Respiratory Failure: A Systematic Review

Culbreth

Goodfellow

2015

Respir Care

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BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is often used in patients withsevere respiratory failure to improve oxygenation and survival. ECMO gives the lungs an opportunity to rest and recover. The addition of prone positioning therapy used concurrently with ECMO can further aid in optimizing alveolar recruitment and reducing ventilator-induced lung injury, ultimately resulting in fewer ICU admission days and improved overall survival. The objective of this review is to perform a systematic analysis of the complications reported with prone positioning and ECMO in the adult population and to briefly report on the patient outcomes in the studies. METHODS: PubMed, MEDLINE, Cochrane Library, and CINAHL were searched from January 1, 1960 to September 14, 2014. Studies were included if they examined both extracorporeal membrane oxygenation and prone positioning simultaneously for the treatment of respiratory failure in the adult population. RESULTS: Seven studies fit the study inclusion criteria (1 prospective cohort study, 3 retrospective cohort studies, and 3 case series). All of the studies in this review reported no occurrence of ECMO cannula dislodgment, and 2 studies reported cannula site bleeding. Chest tube dislodgment and airway dislodgment did not occur in any of the studies included. Bleeding from the chest tube site was reported in 13.5% of prone positioning maneuvers in 1 study, and the rest of the studies reported no evidence of chest tube site bleeding. Of the 2 studies that reported hemodynamic instability during the prone positioning maneuvers, very few adverse hemodynamic episodes were reported. The authors who reported adverse effects stated that the episodes were quickly and successfully reversible. CONCLUSIONS: This review highlights the limited complications documented during prone positioning and ECMO. More studies are needed to assess the clinical efficacy of the addition of prone positioning therapy to ECMO for patients in severe respiratory failure.

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Section: What This Paper Contributes To Our Knowledgementioning

confidence: 99%