Prone position enhances oxygenation and facilitates weaning from percutaneous extracorporeal membrane oxygenation in infants after the bidirectional Glenn procedure.

Abstract

The prone position has been shown to improve oxygenation in patients with acute respiratory distress syndrome (ARDS) and is commonly used in mechanically ventilated patients. However, the short-term efficacy and outcomes of prone positioning in infants requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) after a bidirectional Glenn procedure have not been reported. A 6-month-old female infant with pulmonary atresia and intact ventricular septum underwent a bidirectional Glenn procedure. On postoperative day 6, the patient was extubated and showed favorable progress. On postoperative day 12, the patient developed ARDS and Glenn failure, leading to the initiation of V-V ECMO through the right subclavian vein (drainage site) and femoral vein (infusion site) for severe hypoxemia. After initial management in the supine and lateral positions failed to improve oxygenation, the prone position was introduced from postoperative day 25 onward, for 8-12 h daily. Oxygenation gradually improved over 12 days, and the prone positioning was discontinued on postoperative day 38. The patient was successfully weaned from V-V ECMO on postoperative day 42, weaned from the mechanical ventilation on day 69, and discharged from the pediatric intensive care unit on day 82 without significant neurological complications. Prone position can be safely implemented in infants undergoing V-V ECMO after a bidirectional Glenn procedure, which might contribute to improving oxygenation and weaning.