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

Seethala, Raghu R.; Frakes, Michael A.; Cocchi, Michael N.; Cohen, Jason E.; Dargin, James; Friedman, Frank; Grant, Christian; Kaye, Adam; Wilcox, Susan R.

OBJECTIVES: 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. DESIGN: Retrospective observational study. SETTING: Single critical care transport agency serving multiple centers in the greater Boston area. PATIENTS: All transports of intubated patients in the prone position with severe hypoxemic respiratory failure secondary to coronavirus disease 2019. INTERVENTIONS: 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. MEASUREMENTS AND MAIN RESULTS: A total of 25 patients were transported in prone position. The mean Pao(2):Fio(2) 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. CONCLUSIONS: 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.