Feasibility and Safety of Prone Position Transport for Severe Hypoxemic Respiratory Failure Due to Coronavirus Disease 2019.

Abstract

To assess the safety and feasibility of a new protocol for interhospital critical care transport of mechanically ventilated patients in the prone position during the coronavirus disease 2019 pandemic by nurse and paramedic critical care transport teams. Retrospective observational study. Single critical care transport agency serving multiple centers in the greater Boston area. All transports of intubated patients in the prone position with severe hypoxemic respiratory failure secondary to coronavirus disease 2019. Records were reviewed for patients transported in the prone position. Major adverse events in transport, defined as severe hypoxemia (oxygen saturation < 80% or an absolute decrease in oxygen saturation > 10%), hypotension (mean arterial pressure < 65 mm Hg) not responsive to vasopressors or inotropes, endotracheal tube or vascular catheter dislodgement, and cardiac arrest, were recorded. A total of 25 patients were transported in prone position. The mean Pao2:Fio2 ratio in the group was 101.3 mm Hg, and 76% (n = 19) were on vasopressors. Fourteen patients (56%) had hypotension with at least one episode of mean arterial pressure less than 65 mm Hg en route, and seven (28%) had an episode of oxygen desaturation less than 88%. Only one major adverse event of severe hypoxemia (oxygen saturation < 80%) was noted. Critical care transport of severe hypoxemic respiratory failure patients with coronavirus disease 2019 in the prone position is safe when performed by a dedicated team of critical care nurse and paramedics with an established protocol.