Proning the extracorporeal membrane oxygenation plus Impella: a case report

The prone position is recommended as supportive therapy in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). However, little is known about prone position ventilation in patients with cardiogenic shock supported by extracorporeal membrane oxygenation (ECMO) plus Impella (ECPELLA) developing ARDS.

A 66-year-old man with severe left ventricular dysfunction was admitted to a non-academic ECMO centre for a high-risk coronary artery bypass grafting. He developed post-cardiotomy shock needing ECMO support. To improve left ventricular unloading, an Impella was inserted 2 days later. One day later, he developed ARDS and needed prone position ventilation with ECPELLA in situ. After 4 weeks, he was discharged from the intensive care unit.

Previous studies demonstrated that prone positioning could help avoid an additional venous cannula in veno-arterial ECMO patients, which is associated with mechanical complications. In this case, there was a promising role for unloading the left ventricle with Impella during veno-arterial ECMO and, for proning, the patient with cardiogenic shock developing ARDS during ECMO support without the need for an extra venous cannula.