title: Prone and ECMO - a contradiction per se?
abstract: Acute respiratory distress syndrome (ARDS) still represents a serious problem in clinical routine and is associated with a high mortality. Several concepts are known for special treatment, but, in some instances, the application of an extracorporeal membrane oxygenation (ECMO) is necessary for both the improvement of oxygenation and the elimination of carbon dioxide (CO(2)). One basic aspect in lung protective ventilation in this context is alveolar recruitment, which can be achieved by different approaches, such as "the open lung concept", according to Lachmann, or by additional kinetic therapy. The most exposed feature of this entity is 'prone', which may be quite challenging in patients requiring extracorporeal support or organ replacement therapy under ongoing critical illness. We report two outstanding cases of prone under conditions of a veno-venous ECMO therapy which improved significantly under this position. Furthermore, we reflect critically possible risk factors and adverse events of such procedures and afford a current view from the literature.
authors.affiliation: Department of Thoracic- and Cardiovascular Surgery, Klinikum Oldenburg, D-26133 Oldenburg, Germany. jens-litmathe@t-online.de
authors.forename: J
authors.initials: J
authors.lastname: Litmathe
authors.forename: C
authors.initials: C
authors.lastname: Sucker
authors.forename: J
authors.initials: J
authors.lastname: Easo
authors.forename: L
authors.initials: L
authors.lastname: Wigger
authors.forename: O
authors.initials: O
authors.lastname: Dapunt
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult