Prone positioning in the presence of Acute Respiratory Distress Syndrome (ARDS) has been a controversial topic over the years due to variable results. Recent studies, however, have shown a significant decrease in mortality rates. These findings suggest that prone positioning has beneficial effects, and should therefore be performed in most critical care settings. Increased frequency of this therapy has led to providers being called to transport these patients; often times for ECMO support at the receiving facility. Can transport providers safely transport these patients in the prone position? In this episode, we review ARDS, the specific benefits of prone positioning, and how we can effectively perform these transfers.
“Prep and Flip” video:
DellaVolpe, J. D., Lovett, J., Martin-Gill, C., & Guyette, F. X. (2016). Transport of mechanically ventilated patients in the prone position. Prehospital Emergency Care, 20(5), 643-647. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27075163.
Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, et al. (2013). Prone positioning in severe acute respiratory distress syndrome. The New England Journal of Medicine, 368, 2159–2168.
Koulouras, V., Papathanakos, G., Papathanasiou, A., & Nakos, G. (2016). Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World Journal of Critical Care Medicine, 5(2), 121-136. Retrieved from HYPERLINK “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848155/#B23” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848155/#B23.
Tonna, J. E. (2016). Prone Positioning: An experience of actually doing it. American College of Emergency Physicians. Retrieved from HYPERLINK “https://www.acep.org/Content.aspx?ID=96603#sm.0001cfrizt2g6e25pno2qn6iewo9v” https://www.acep.org/Content.aspx?ID=96603#sm.0001cfrizt2g6e25pno2qn6iewo9v
Weingart, S. (2017, June 03). Podcast 124 – The Logistics of Proning for ARDS. Retrieved from https://emcrit.org/racc/logistics-proning/
Hello,
Excellent job. I have just discovered your podcasts.
Here is an article discussing cardiac arrest in prone patients that you may find interesting.
Miranda CC, Newton MC. Successful defibrillation in the prone position. Br J Anaesth. 2001;87(6):937-938.
We will definitely check it out. Thanks for listening!
Thanks for the additional references! Don’t forget to check out our updated info on Episode 54.
Please Look also at David Jersey Transport of a prone position ards patient and Nighat Khan (editorial) aeromedical transport in the prone position. Good job! Greetings from Poland