Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients
Background Severe COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) may warrant extracorporeal membrane oxygenation (ECMO). We evaluated the safety and physiologic changes in oxygenation and hemodynamic profile during ECMO, prone positioning, and the two modalities combined in patients...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-11-01
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| Series: | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| Online Access: | https://doi.org/10.1177/11795484221134451 |
| _version_ | 1828187090188238848 |
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| author | Stephanie L Ong Hossam Tantawy Roland Assi Astha Chichra Miriam M Treggiari |
| author_facet | Stephanie L Ong Hossam Tantawy Roland Assi Astha Chichra Miriam M Treggiari |
| author_sort | Stephanie L Ong |
| collection | DOAJ |
| description | Background Severe COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) may warrant extracorporeal membrane oxygenation (ECMO). We evaluated the safety and physiologic changes in oxygenation and hemodynamic profile during ECMO, prone positioning, and the two modalities combined in patients receiving veno-venous (VV) ECMO. Methods Cohort study of consecutive adult patients with COVID-19-associated ARDS requiring VV-ECMO, classified into three groups: ECMO support only; Prone positioning only; and Prone positioning during ECMO. We collected hemodynamic, respiratory and ventilation variables as follows: pre-treatment, 1, 6, and 24 h post-treatment, and documented treatment-related complications. On-treatment variables were compared with pre-treatment using one-sample paired t-test with Bonferroni correction. Results Fourteen patients (mean age 48.1 [SD 9.3] years, male [100%]) received VV-ECMO. Of those, 10 patients had data during prone positioning alone and seven had data while proned on ECMO. While on ECMO, patients had improvement in oxygen saturation, PaO 2 /FiO 2 ratio, and minute ventilation up to 24 h post-treatment. Vasopressor requirements increased with ECMO at 1 h and 24 h post-treatment. Prone positioning was not associated with clinically significant hemodynamic or respiratory changes, either alone or during ECMO support. All patients sustained deep tissue injuries, but only those on the face or chest were related to prone positioning. Three patients required cannula replacement. In-hospital mortality was 43%. Conclusions VV-ECMO and prone positioning in patients with COVID-19 ARDS was overall well-tolerated; however, physiologic improvements were marginal, and patients sustained deep tissue injuries. Although this was a selected population with high mortality, our data call into question the benefits of these management modalities in this severe COVID-19 population. |
| first_indexed | 2024-04-12T07:29:56Z |
| format | Article |
| id | doaj.art-1815ba7f71754386a4823e01553fb4d1 |
| institution | Directory Open Access Journal |
| issn | 1179-5484 |
| language | English |
| last_indexed | 2024-04-12T07:29:56Z |
| publishDate | 2022-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| spelling | doaj.art-1815ba7f71754386a4823e01553fb4d12022-12-22T03:42:05ZengSAGE PublishingClinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine1179-54842022-11-011610.1177/11795484221134451Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 PatientsStephanie L Ong0Hossam Tantawy1Roland Assi2Astha Chichra3Miriam M Treggiari4 Department of Anesthesiology, , New Haven, CT, USA Department of Anesthesiology, , New Haven, CT, USA Department of Surgery, Section of Cardiac Surgery, , New Haven, CT, USA Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, , New Haven, CT, USA Department of Anesthesiology, Duke University, Durham, NC, USABackground Severe COVID-19-associated Acute Respiratory Distress Syndrome (ARDS) may warrant extracorporeal membrane oxygenation (ECMO). We evaluated the safety and physiologic changes in oxygenation and hemodynamic profile during ECMO, prone positioning, and the two modalities combined in patients receiving veno-venous (VV) ECMO. Methods Cohort study of consecutive adult patients with COVID-19-associated ARDS requiring VV-ECMO, classified into three groups: ECMO support only; Prone positioning only; and Prone positioning during ECMO. We collected hemodynamic, respiratory and ventilation variables as follows: pre-treatment, 1, 6, and 24 h post-treatment, and documented treatment-related complications. On-treatment variables were compared with pre-treatment using one-sample paired t-test with Bonferroni correction. Results Fourteen patients (mean age 48.1 [SD 9.3] years, male [100%]) received VV-ECMO. Of those, 10 patients had data during prone positioning alone and seven had data while proned on ECMO. While on ECMO, patients had improvement in oxygen saturation, PaO 2 /FiO 2 ratio, and minute ventilation up to 24 h post-treatment. Vasopressor requirements increased with ECMO at 1 h and 24 h post-treatment. Prone positioning was not associated with clinically significant hemodynamic or respiratory changes, either alone or during ECMO support. All patients sustained deep tissue injuries, but only those on the face or chest were related to prone positioning. Three patients required cannula replacement. In-hospital mortality was 43%. Conclusions VV-ECMO and prone positioning in patients with COVID-19 ARDS was overall well-tolerated; however, physiologic improvements were marginal, and patients sustained deep tissue injuries. Although this was a selected population with high mortality, our data call into question the benefits of these management modalities in this severe COVID-19 population.https://doi.org/10.1177/11795484221134451 |
| spellingShingle | Stephanie L Ong Hossam Tantawy Roland Assi Astha Chichra Miriam M Treggiari Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine |
| title | Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients |
| title_full | Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients |
| title_fullStr | Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients |
| title_full_unstemmed | Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients |
| title_short | Combined Use of ECMO, Prone Positioning, and APRV in the Management of Severe COVID-19 Patients |
| title_sort | combined use of ecmo prone positioning and aprv in the management of severe covid 19 patients |
| url | https://doi.org/10.1177/11795484221134451 |
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