Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study
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...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-07-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000948 |
| _version_ | 1797770631583891456 |
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| author | Timothy Zhang, BSc Anton Nikouline, MD, FRCPC Jamie Riggs, MD Brodie Nolan, MD, MSc, FRCPC Andy Pan, MD, FRCPC, DRCPSC Michael Peddle, MD, FRCPC Eddy Fan, MD, PhD, FRCPC Lorenzo Del Sorbo, MD, FRCPC John Granton, MD, FRCPC |
| author_facet | Timothy Zhang, BSc Anton Nikouline, MD, FRCPC Jamie Riggs, MD Brodie Nolan, MD, MSc, FRCPC Andy Pan, MD, FRCPC, DRCPSC Michael Peddle, MD, FRCPC Eddy Fan, MD, PhD, FRCPC Lorenzo Del Sorbo, MD, FRCPC John Granton, MD, FRCPC |
| author_sort | Timothy Zhang, BSc |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T21:26:01Z |
| format | Article |
| id | doaj.art-c696fd4bcf5b4d5798daa3476d8b7e86 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-03-12T21:26:01Z |
| publishDate | 2023-07-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-c696fd4bcf5b4d5798daa3476d8b7e862023-07-28T09:28:12ZengWolters KluwerCritical Care Explorations2639-80282023-07-0157e094810.1097/CCE.0000000000000948202307000-00016Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort StudyTimothy Zhang, BSc0Anton Nikouline, MD, FRCPC1Jamie Riggs, MD2Brodie Nolan, MD, MSc, FRCPC3Andy Pan, MD, FRCPC, DRCPSC4Michael Peddle, MD, FRCPC5Eddy Fan, MD, PhD, FRCPC6Lorenzo Del Sorbo, MD, FRCPC7John Granton, MD, FRCPC81 Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.2 Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.3 Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.3 Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.5 Ornge, Mississauga, ON, Canada.2 Division of Emergency Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.9 Department of Medicine, University Health Network, Toronto, ON, Canada.9 Department of Medicine, University Health Network, Toronto, ON, Canada.9 Department of Medicine, University Health Network, Toronto, ON, Canada.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.http://journals.lww.com/10.1097/CCE.0000000000000948 |
| spellingShingle | Timothy Zhang, BSc Anton Nikouline, MD, FRCPC Jamie Riggs, MD Brodie Nolan, MD, MSc, FRCPC Andy Pan, MD, FRCPC, DRCPSC Michael Peddle, MD, FRCPC Eddy Fan, MD, PhD, FRCPC Lorenzo Del Sorbo, MD, FRCPC John Granton, MD, FRCPC Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study Critical Care Explorations |
| title | Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study |
| title_full | Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study |
| title_fullStr | Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study |
| title_full_unstemmed | Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study |
| title_short | Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study |
| title_sort | outcomes of patients transported in the prone position to a regional extracorporeal membrane oxygenation center a retrospective cohort study |
| url | http://journals.lww.com/10.1097/CCE.0000000000000948 |
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