%0 Journal Article
%T Prone Position Ventilation Used during a Transfer as a Bridge to Ecmo Therapy in Hantavirus-Induced Severe Cardiopulmonary Syndrome
%A R. Cornejo
%A D. Ugalde
%A O. Llanos
%A P. Bisbal
%A L. De la Barrera
%A C. Romero
%A R. Neira
%A Roberto Gonz¨˘lez
%A J. Gajardo
%J Case Reports in Critical Care
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/415851
%X Background. Transport of critically ill patients is a complex issue. We present a case using prone positioning as a bridge to extracorporeal membrane oxygenation (ECMO), performed by a critical retrieval team from a university hospital. Case Report. A 28-year-old male developed fever, progressive respiratory failure, and shock. He was admitted to ICU from a public hospital, and mechanical ventilation was begun, but clinical response was not adequate. ECMO was deemed necessary due to severe respiratory failure and severe shock. A critical retrieval team of our center was assembled to attempt transfer. Prone positioning was employed to stabilize and transfer the patient, after risk-benefit assessment. Once in our hospital, ECMO was useful to resolve shock and pulmonary edema secondary to Hantavirus cardiopulmonary syndrome. Finally, he was discharged with normal functioning. Conclusion. This case exemplifies the relevance of a retrieval team and bridge therapy. Prone positioning improves oxygenation and is safe to perform as transport if performed by a trained team as in this case. Preparation and organization is necessary to improve outcomes, using teams and organized networks. Catastrophic respiratory failure and shock should not be contraindications to transferring patients, but it must be done with an experienced team. 1. Introduction Transport of critically ill patients remains a complex issue; respiratory or hemodynamic instability increases the risks during the procedures required to transfer mechanically ventilated patients between units and particularly between ICUs at different hospitals. Interhospital transportation of critically ill patients is of paramount importance when patients require therapies not available at the hospital of origin, often life-saving measures such as extracorporeal membrane oxygenation (ECMO). In this context patients may require bridging therapy to overcome life-threatening cardiopulmonary failure for a time long enough to reach destination, performed by a specialized team, experienced in those measures. The aim of this report is to communicate how the assessment and management by a critical care rescue team allowed the transfer of a patient with severe respiratory failure and concomitant circulatory failure in prone positioning and high dose of vasoactive drugs. 2. Case Report A 28-year-old male, previously healthy, was admitted to a public hospital in Santiago because of respiratory failure and hypotension. He referred a history of 7 days of fever, progressive shortness of breath, abdominal pain, and vomiting. The
%U http://www.hindawi.com/journals/cricc/2013/415851/