PMID- 24338657
OWN - NLM
STAT- MEDLINE
DCOM- 20160422
LR  - 20201209
IS  - 1724-6040 (Electronic)
IS  - 0391-3988 (Linking)
VI  - 36
IP  - 11
DP  - 2013 Nov
TI  - Prone position during ECMO is safe and improves oxygenation.
PG  - 821-32
LID - 10.5301/ijao.5000254 [doi]
AB  - PURPOSE: Combination of prone positioning (PrP) and extracorporeal membrane 
      oxygenation (ECMO) might be beneficial in severe acute respiratory distress 
      syndrome (ARDS), because both approaches are recommended. However, PrP during 
      ECMO might be associated with complications such as dislocation of ECMO cannulae. 
      We investigated complications and change of oxygenation effects of PrP during 
      ECMO to identify "responders" and discuss our results considering different 
      definitions of response in the literature.
 METHODS: Retrospective analysis of 
      complications, gas exchange, and invasiveness of mechanical ventilation during 
      first and second PrP on ECMO at specified time points (before, during, and after 
      PrP). We used multivariate nonparametric analysis of longitudinal data (MANOVA) 
      to compare changes of mechanical ventilation and hemodynamics associated with the 
      first and second procedures.
 RESULTS: In 12 ECMO patients, 74 PrPs were 
      performed (median ECMO duration: 10 days (IQR: 6.3-
15.5 days)). No dislocations 
      of intravascular catheters/cannulae, endotracheal tubes or chest tubes were 
      observed. Two PrPs had to be interrupted (endotracheal tube obstruction, acute 
      pulmonary embolism). PaO2/FiO2-ratio increased associated with the first and 
      second PrP (p = 0.002) and lasted after PrP in 58% of these turning procedures 
      ("responders") without changes in ECMO blood flow, respiratory pressures, minute 
      ventilation, portion of spontaneously triggered breathing, and compliance. 
      Hemodynamics did not change with exception of increased mean pulmonary arterial 
      pressure during PrP and decrease after PrP (p<0.001), while norepinephrine dosage 
      decreased (p = 0.03) (MANOVA).
 CONCLUSIONS: Prone position during ECMO is safe 
      and improves oxygenation even after repositioning. This might ameliorate 
      hypoxemia and reduce the harm from mechanical ventilation.
FAU - Kipping, Valesca
AU  - Kipping V
AD  - Department of Anesthesiology and Intensive Care Medicine, Charite - 
      Universitatsmedizin Berlin, Berlin - Germany.
FAU - Weber-Carstens, Steffen
AU  - Weber-Carstens S
FAU - Lojewski, Christian
AU  - Lojewski C
FAU - Feldmann, Paul
AU  - Feldmann P
FAU - Rydlewski, Antje
AU  - Rydlewski A
FAU - Boemke, Willehad
AU  - Boemke W
FAU - Spies, Claudia
AU  - Spies C
FAU - Kastrup, Marc
AU  - Kastrup M
FAU - Kaisers, Udo X
AU  - Kaisers UX
FAU - Wernecke, Klaus-D
AU  - Wernecke KD
FAU - Deja, Maria
AU  - Deja M
LA  - eng
PT  - Journal Article
DEP - 20131002
PL  - United States
TA  - Int J Artif Organs
JT  - The International journal of artificial organs
JID - 7802649
SB  - IM
MH  - *Extracorporeal Membrane Oxygenation
MH  - Humans
MH  - Prone Position
MH  - Prospective Studies
MH  - *Respiratory Distress Syndrome
MH  - Retrospective Studies
EDAT- 2013/12/18 06:00
MHDA- 2016/04/23 06:00
CRDT- 2013/12/17 06:00
PHST- 2013/07/30 00:00 [accepted]
PHST- 2013/12/17 06:00 [entrez]
PHST- 2013/12/18 06:00 [pubmed]
PHST- 2016/04/23 06:00 [medline]
AID - 6394D191-D897-477C-A487-7F18D7B2C4AF [pii]
AID - 10.5301/ijao.5000254 [doi]
PST - ppublish
SO  - Int J Artif Organs. 2013 Nov;36(11):821-32. doi: 10.5301/ijao.5000254. Epub 2013 
      Oct 2.