JTCVS Tech . Efficacy of Proning in Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation

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JTCVS Tech


. 2022 Sep 23.
doi: 10.1016/j.xjtc.2022.08.027. Online ahead of print.
Efficacy of Proning in Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation


Stephanie H Chang ¹ , Deane E Smith ¹ , Julius A Carillo ¹ , Philip M Sommer ² , Travis C Geraci ¹ , David Williams ¹ , Darien Paone ¹ , Ronald Goldernberg ³ , Justin Chan ¹ , Zachary N Kon ⁴ , Aubrey C Galloway ¹ , Nader Moazami ¹



Affiliations

• PMID: 36168330
• PMCID: PMC9499985
• DOI: 10.1016/j.xjtc.2022.08.027

Abstract

Objectives: Proning patients with acute respiratory distress syndrome (ARDS) has been associated with increased survival, though little data exists evaluating the safety and feasibility of proning ARDS patients on extracorporeal membrane oxygenation (ECMO).
Methods: A single-institution retrospective review of all patients with ARDS placed on ECMO between March 1^st-May 31^st, 2020 was performed. All proning events were evaluated for complications, as well as change in compliance, sweep, oxygenation and flow. The primary outcome of this study was the rate major morbidity associated with proning while on ECMO.
Results: 30 patients were placed on ECMO for ARDS, with 12 patients (40%) proned while on ECMO. 83 proning episodes occurred, with a median of 7 per patient (IQR 3-9). No ECMO cannula-associated bleeding, cannula displacement, or endotracheal tune dislodgements occurred (0%) . Oropharyngeal bleeding occurred twice (50%).Four patients were proned with chest tubes in place and none had complications (0%). Lung compliance improved after proning in 70 events (84%), from a mean of 15.4mL/mmHg pre to 20.6mL/mmHg post (p<0.0001). Sweep requirement decreased in 36 events (43%). Oxygenation improved in 63 events (76%), from a mean pO₂ of 86 pre to 103 post (p<0.0001). Mean ECMO flow was unchanged.
Conclusions: Proning in patients with ARDS on ECMO is safe with an associated improvement in lung mechanics. With careful planning and coordination, these data support the practice of appropriately proning patients with severe ARDS, even if they are on ECMO.

Keywords: ARDS, Acute respiratory distress syndrome; BMI, Body mass index; COVID-19, Coronavirus Disease – 19; CXR, Chest x-ray; ECMO, Extracorporeal membrane oxygenation; EMCO; FiO2, Fractioned of inhaled oxygen; IQR, Interquartile range; NYULH, New York University Langone Health; PEEP, Positive end-expiratory pressure; PIP, Peak inspiratory pressure; Proning; VA-ECMO, veno-arterial extracorporeal membrane oxygenation; VV-ECMO, Veno-venous extracorporeal membrane oxygenation; pCO2, Partial pressure of arterial carbon dioxide; pO2, Partial pressure of oxygen.