Guidelines for prone positioning placement under vvECMO were adapted from
the supplementary appendix of Guérin C, Reignier J, Richard J-C, et al. Prone
positioning in severe acute respiratory distress syndrome. N Engl J Med
2013;368:2159-68. DOI: 10.1056/NEJMoa1214103.
The protocol stated that 8 persons were required for the procedure. One person was
dedicated to the management of the head of the patient, one to the management of
the vvECMO line and one to set a new bed sheet and specific pillows. The person at
the foot of the bed had to coordinate the steps of the procedure. The 4 other persons
stood at each side of the bed. A physician was systematically in the room.
Specifically, under vvECMO, special attention was given to the following points:
-1) The direction of the rotation (to the left or to the right) was decided giving priority
to the vvECMO lines.
-2) The person dedicated to the vvECMO lines verified:
- The monitoring of ECMO flow,
- The integrity of the lines (no kinking…),
- The integrity of the dressing covering the insertions of the lines.
-3) A specific triangular pillow was placed under the anterior iliac crests to avoid any
compression of the lines inserted in the femoral area (Figure 1).
-4) Nurse surveillance included:
- Detection of bleeding
- No kinking in the lines
- Monitoring the ECMO flow
A description of the procedure is provided in Figure 2.
Adverse events related to prone positioning placement under vvECMO.
No serious adverse event was recorded in this patient. Usual skin abrasions on
knees were found after the return in supine position despite the adapted protection.
Figure 1: Specific pillows used for prone positioning placement. Special attention was
given to the triangular pillow (Arrow)
Figure 2: Procedure for prone positioning placement. Panel A: patient moved along
the horizontal plane to the opposite side of the bed. Panel B: « Sagitallization ».
Panel C: rotation and levitation for the insertion of the pillow. Panel D: Patient in final
prone positioning.
A
B
C
D