Prone Position Ventilation Used during a Transfer as a Bridge to Ecmo Therapy in Hantavirus-Induced Severe Cardiopulmonary Syndrome

Abstract

Background. Transport of critically ill patients is a complex issue. We present a case using prone positioning as a bridge to extracorporeal membrane oxygenation (ECMO), performed by a critical retrieval team from a university hospital. Case Report. A 28-year-old male developed fever, progressive respiratory failure, and shock. He was admitted to ICU from a public hospital, and mechanical ventilation was begun, but clinical response was not adequate. ECMO was deemed necessary due to severe respiratory failure and severe shock. A critical retrieval team of our center was assembled to attempt transfer. Prone positioning was employed to stabilize and transfer the patient, after risk-benefit assessment. Once in our hospital, ECMO was useful to resolve shock and pulmonary edema secondary to Hantavirus cardiopulmonary syndrome. Finally, he was discharged with normal functioning. Conclusion. This case exemplifies the relevance of a retrieval team and bridge therapy. Prone positioning improves oxygenation and is safe to perform as transport if performed by a trained team as in this case. Preparation and organization is necessary to improve outcomes, using teams and organized networks. Catastrophic respiratory failure and shock should not be contraindications to transferring patients, but it must be done with an experienced team.

Hantavirus induced cardiopulmonary syndrome: A public health concern

“…Transfer of such patients is a very critical issue due the gravity of their condition that can lead to hypoxic respiratory failure. According to one of the many case reports, a patient was transferred in prone position by a specialized team . Recently a patient with confirmed hantavirus cardiopulmonary syndrome who qualified for ECMO was successfully treated with high volume continuous hemofiltration .…”

“…According to one of the many case reports, a patient was transferred in prone position by a specialized team. 63 Recently a patient with confirmed hantavirus cardiopulmonary syndrome who qualified for ECMO was successfully treated with high volume continuous hemofiltration. 64 The implementation of high volume continuous hemofiltration along with protective ventilation reversed the shock within few hours and might have prompted the patient's recovery.…”

Prone transportation to an ECMO center

“…Unfortunately, further studies need to be done to determine the efficacy of the checklist. Although there have not been any reported adverse events with prone transport – only a small number of cases have been reported [ 6 , 7 , 8 , 9 , 10 ]. We believe our case is unique in the use of an ad hoc method in transporting a patient prone safely and demonstrates the ease with which it can be done.…”

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

“…These include impeded IV and airway access, and difficulties performing standard cardiopulmonary resuscitation (CPR) (9). While there have been small numbers of case reports discussing adverse events related to prone transport (9)(10)(11)(12)(13), there is also evidence that CPR and defibrillation can be reasonably performed in the prone position (14,15). Since there is a relative paucity of data on the safety of prone positioning in patient transport compared with its in-hospital use, it has been difficult to determine the relative risk and benefits to prone transport.…”