Successful use of an automated proning system to achieve prone positioning in a patient with severe ARDS requiring veno-venous ECMO
Abstract
A morbidly obese middle aged woman in her 40’s presented to another hospital with methicillin resistant
staphylococcus aureus pneumonia and subsequently developed severe acute respiratory distress syndrome. Her
oxygenation demonstrated no improvement with low tidal volume ventilation, paralysis, or prostagladin therapy.
She was unable to be manually proned secondary to her habitus. She was subsequently transferred to our facility,
where she was initiated on VV-ECMO. Maximal flow through the ECMO circuit was inadequate for oxygenation
given significant systemic shunt through her native lungs. In order to optimize lung protective ventilation and
treat ARDS, we used an automated kinetic system (Rotoprone Therapy System) to prone the patient. To our
knowledge, this is the first description in the literature of using an automated proning system with an ECMO
circuit in place. This report describes the technique we used to safely perform axial rotations for two days with
fewer providers required than manual proning.