The Effects of Prone Positioning with VV-ECMO Support in Adult Acute Respiratory Distress Syndrome Patients: A Scoping Review of the Evidence
Keywords:
prone position, acute respiratory distress syndrome, ARDS, ECMO, extracorporeal membrane oxygenation, ECLS, extracorporeal life support, venovenous, VV-ECMO, adult, humanAbstract
Background: Acute Respiratory Distress Syndrome (ARDS) is a severe form of respiratory failure associated with high morbidity and mortality. Optimizing gas exchange while minimizing ventilator-induced lung injury (VILI) is crucial when managing ARDS patients. Lung-protective mechanical ventilation (LPV) is widely used, but variability in alveolar injury poses treatment challenges. Prone positioning and venovenous extracorporeal membrane oxygenation (VV-ECMO) have emerged as adjunct oxygenation therapies in recent years. Proning redistributes mechanical forces and improves ventilation distribution. Respiratory ECMO, or VV-ECMO, provides gas exchange support and facilitates lung-protective ventilation. However, the combined efficacy of these interventions remains unclear.
Objective: This scoping review aims to summarize the available evidence on the effects of prone positioning in adult patients with ARDS requiring VV-ECMO.
Methodology: A scoping review design was chosen to comprehensively explore the literature on VV-ECMO therapy in prone adult ARDS patients, including historical progress, current practices, and future directions. The study will utilize a rigorous search strategy across multiple electronic databases and employ specific inclusion and exclusion criteria to identify relevant articles. Screening protocols will be implemented to ensure the selection of appropriate studies. The search strategy results will be reported using a PRISMA flow diagram. Data characterization will utilize an extraction table to capture key study characteristics and findings.
Contributions: This scoping review aims to inform future evidence-based proning protocols and guidelines when utilizing VV-ECMO and to facilitate standardized practices and improved healthcare delivery for patients with ARDS. This review will enable perfusionists to proactively anticipate and manage potential complications or challenges associated with proning and combined VV-ECMO therapy. This study aims to contribute to advancing the cardiovascular perfusion field by guiding research directions and identifying current knowledge and practice gaps.
Keywords: Prone position, ARDS, acute respiratory distress syndrome, ECMO, extracorporeal membrane oxygenation, ECLS, extracorporeal life support, venovenous, VV-ECMO, adult, human.
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