Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study

Timothy Zhang; Anton Nikouline; Jamie Riggs; Brodie Nolan; Andy Pan; Michael Peddle; Eddy Fan; Lorenzo Del Sorbo; John Granton

doi:10.1097/CCE.0000000000000948

Outcomes of Patients Transported in the Prone Position to a Regional Extracorporeal Membrane Oxygenation Center: A Retrospective Cohort Study

Crit Care Explor. 2023 Jul 21;5(7):e0948. doi: 10.1097/CCE.0000000000000948. eCollection 2023 Jul.

Authors

Timothy Zhang¹, Anton Nikouline², Jamie Riggs³, Brodie Nolan^{3

4

5}, Andy Pan^{5

6

7

8}, Michael Peddle^{2

5}, Eddy Fan^{9

10

11}, Lorenzo Del Sorbo^{9

10}, John Granton^{9

10}

Affiliations

¹ 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.
⁴ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
⁵ Ornge, Mississauga, ON, Canada.
⁶ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁷ Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
⁸ Division of Critical Care Medicine, Montfort Hospital, Ottawa, ON, Canada.
⁹ Department of Medicine, University Health Network, Toronto, ON, Canada.
¹⁰ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Abstract

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.

Keywords: COVID-19; acute respiratory distress syndrome; critical care transport; extracorporeal membrane oxygenation; prone transport; safety.