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Luangrath MA, Chegondi M, Badheka A. Outcome of extracorporeal membrane oxygenation support among children with methicillin-resistant Staphylococcus aureus infection: A single-center experience. Perfusion 2024:2676591241268706. [PMID: 39097819 DOI: 10.1177/02676591241268706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
Introduction: The use of extracorporeal membrane oxygenation (ECMO) in children continues to increase nationally, including patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. Survival of pediatric patients with MRSA sepsis has not improved over the last 20 years. We sought to review our institutional experience and outcomes of ECMO support among children with MRSA infection.Methods: Children aged 0-19 years who received ECMO support from October 2014 to June 2021 were reviewed retrospectively. Patients with laboratory confirmed MRSA infections were identified.Results: Out of 88 unique pediatric patients requiring ECMO support, eight patients had documented MRSA infections. The duration of mechanical ventilation prior to ECMO initiation was an average of seven days (range 0.7 to 21.8 days). The median ECMO duration was 648.1 h (range 15.5 to 1580.5 h). Five patients were successfully decannulated; however, only two patients survived to discharge. The two surviving patients were both cannulated via VV-ECMO. Mechanical ventilation prior to ECMO was 4.5 and 21.8 days in these cases with run durations of 18.9 and 29.9 days, respectively.Conclusions: Our institutional survival of patients with MRSA on ECMO is lower than what has been reported in recent database studies, but notably, 62.5% were successfully decannulated. While both surviving patients were supported with VV-ECMO, there was no other clear trend in factors that contributed to survival. MRSA continues to be a source of significant morbidity and mortality among pediatric patients. On-going investigation of outcomes and factors contributing to survival in patients with MRSA infection on ECMO is warranted.
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Affiliation(s)
- Mitchell A Luangrath
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Health Care, Iowa City, IA, USA
| | - Madhuradhar Chegondi
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Health Care, Iowa City, IA, USA
| | - Aditya Badheka
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Health Care, Iowa City, IA, USA
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Sheykhsaran E, Abbasi A, Memar MY, Ghotaslou R, Baghi HB, Mazraeh FN, Laghousi D, Sadeghi J. The role of Staphylococcus aureus in cystic fibrosis pathogenesis and clinico-microbiological interactions. Diagn Microbiol Infect Dis 2024; 109:116294. [PMID: 38678689 DOI: 10.1016/j.diagmicrobio.2024.116294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/05/2024] [Accepted: 03/29/2024] [Indexed: 05/01/2024]
Abstract
Cystic fibrosis (CF) is a progressive and inherited disease that affects approximately 70000 individuals all over the world annually. A mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene serves as its defining feature. Bacterial infections have a significant impact on the occurrence and development of CF. In this manuscript, we discuss the role and virulence factors of Staphylococcus aureus as an important human pathogen with the ability to induce respiratory tract infections. Recent studies have reported S. aureus as the first isolated bacteria in CF patients. Methicillin-resistant Staphylococcus aureus (MRSA) pathogens are approximately resistant to all β-lactams. CF patients are colonized by MRSA expressing various virulence factors including toxins, and Staphylococcal Cassette Chromosome mec (SCCmec) types, and have the potential for biofilm formation. Therefore, variations in clinical outcomes will be manifested. SCCmec type II has been reported in CF patients more than in other SCCmec types from different countries. The small-colony variants (SCVs) as specific morphologic subtypes of S. aureus with slow growth and unusual properties can also contribute to persistent and difficult-to-treat infections in CF patients. The pathophysiology of SCVs is complicated and not fully understood. Patients with cystic fibrosis should be aware of the intrinsic risk factors for complex S. aureus infections, including recurring infections, physiological issues, or coinfection with P. aeruginosa.
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Affiliation(s)
- Elham Sheykhsaran
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Abbasi
- Department of Food Science and Technology, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Naeimi Mazraeh
- Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Delara Laghousi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Sadeghi
- Immunology Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Singh A, Singh Y, Pangasa N, Khanna P, Trikha A. Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review. Indian J Crit Care Med 2022; 25:1434-1445. [PMID: 35027806 PMCID: PMC8693124 DOI: 10.5005/jp-journals-10071-24053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Air leak consisting of pneumothorax, pneumomediastinum, and subcutaneous emphysema has been described as one of the complications of coronavirus disease-2019 (COVID-19) infection affecting disease course and outcome. We aimed to conduct a systematic review of published literature to highlight the risk factors, types, and outcomes in COVID-19. Method A systematic search of PubMed, Embase, Scopus, and Google Scholar was performed from November 1, 2019, to February 28, 2021. Seventy-one studies fulfilled the inclusion criteria and 136 adult patients were included in the final analysis. Results Majority of patients were male (75.2%) with the mean age of 58 years. Hypertension was the most common comorbidity followed by diabetes mellitus. Moreover, 12.5% of patients had a history of smoking while 11.7% had preexisting lung disease. Isolated pneumothorax (48.5%) was the most common and 17.65% had developed spontaneous pneumothorax. Mean onset time was 11.6 days and 67% of patients required an intercostal drainage tube for management. Mortality was 40%, and elderly, female gender, obese and hypertensive were at higher risk. Conclusion COVID-19-related air leaks are associated with higher mortality and longer hospital stay and can occur even without positive pressure ventilation. History of smoking and preexisting lung disease has not been shown to increase the incidence of air leak. A well-designed study is required for a better understanding of COVID-19-related air leak. How to cite this article Singh A, Singh Y, Pangasa N, Khanna P, Trikha A. Risk Factors, Clinical Characteristics, and Outcome of Air Leak Syndrome in COVID-19: A Systematic Review. Indian J Crit Care Med 2021;25(12):1434–1445.
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Affiliation(s)
- Abhishek Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Pangasa
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Zhang M, Li X, Bai Y. Prone position nursing combined with ECMO intervention prevent patients with severe pneumonia from complications and improve cardiopulmonary function. Am J Transl Res 2021; 13:4969-4977. [PMID: 34150081 PMCID: PMC8205846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the application value of prone nursing combined with extracorporeal membrane oxygenation (ECMO) in patients with severe pneumonia. METHODS Altogether 96 patients with severe pneumonia from December 2016 to June 2018 were selected as the research participants, and 48 patients were included in the observation group (OG) to receive prone nursing with ECMO, while the other 48 patients were included in the control group (CG) to receive routine nursing with ECMO. Complications, cardiopulmonary function, VAS, SAS, SDS, MMAS-8 scores and nursing satisfaction were compared. RESULTS After nursing, the incidence of complications in the OG was lower than that in the CG, LVEDD and LVESD in OG were lower than those in CG, while LVEF, FEV1 and FVC were higher than those in CG. The scores of VAS, SAS and SDS in OG were lower than those in CG. The MMAS-8 score in the OG was higher than that in the CG. The total nursing satisfaction of the OG was higher than that of the CG (All P<0.05). CONCLUSION Prone nursing combined with ECMO can reduce the incidence of complications of severe pneumonia and improve the cardiopulmonary function of patients, which is worthy of clinical promotion.
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Affiliation(s)
- Min Zhang
- 2A ICU, Shanghai General Hospital Shanghai 201620, China
| | - Xin Li
- 2A ICU, Shanghai General Hospital Shanghai 201620, China
| | - Yu Bai
- 2A ICU, Shanghai General Hospital Shanghai 201620, China
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Correa G, Taylor D, Vogel D, Wyncoll D. A case of broncho-cutaneous fistula secondary to tuberculosis successfully managed with awake veno-venous extracorporeal membrane oxygenation. Respir Med Case Rep 2021; 32:101351. [PMID: 33537201 PMCID: PMC7840998 DOI: 10.1016/j.rmcr.2021.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/07/2020] [Accepted: 01/13/2021] [Indexed: 11/28/2022] Open
Abstract
A broncho-cutaneous fistula (BCF) is a communicating tract between the bronchus and the cutaneous surface of the thoracic wall and can be the primary presenting sign of several disease processes. It has been associated with positive pressure ventilation (PPV), post pneumonectomy, thoracostomy tubes, perforating chest trauma, neoplasia and chronic empyema. We report a case of a 45-year-old immunocompetent man presenting with severe hypercapnic respiratory failure secondary to a BCF as a result of tuberculosis (TB)-related empyema necessitans. Veno-venous extracorporeal membrane oxygenation (VV ECMO) was employed during spontaneous breathing to mitigate the risks of PPV, to facilitate diagnostics and enable targeted treatment. Awake VV ECMO is an effective supportive therapy for complex, destructive lung pathologies with a known reversible aetiology in which PPV would be potentially detrimental.
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Nakatsutsumi K, Sekiya K, Urushibata N, Hosoi M, Arai H, Nagaoka E, Fujiwara T, Morishita K, Aiboshi J, Otomo Y. A successful case of extracorporeal membrane oxygenation treatment for intractable pneumothorax in a patient with COVID-19. Acute Med Surg 2020; 7:e612. [PMID: 33318806 PMCID: PMC7725136 DOI: 10.1002/ams2.612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Some patients with coronavirus disease 2019 (COVID‐19) develop pneumothorax. Tube thoracotomy and bulla resection could generate aerosols and cause virus transmission; the optimal treatment strategy remains unclear. Case Presentation A 57‐year‐old male was transferred as a severe COVID‐19 pneumonia case. On the 16th day after admission, the patient’s respiratory condition deteriorated, and the chest X‐ray revealed the presence of severe right‐sided pneumothorax. A chest drain was immediately inserted; however, a significant air leak continued, and severe ventilator settings were required. Thus, veno‐venous extracorporeal membrane oxygenation (VV‐ECMO) treatment was initiated to allow the lungs to rest. After 10 days of lung‐protective ventilation, the patient was weaned from ECMO and the chest drain was removed on the following day with no major comorbidities. Conclusion The combination of ECMO with lung rest strategy could be a treatment option for intractable pneumothorax with COVID‐19 to avoid unnecessary surgical procedures and aerosol generation.
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Affiliation(s)
- Keita Nakatsutsumi
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Kosuke Sekiya
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Nao Urushibata
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Marie Hosoi
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Koji Morishita
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center Tokyo Medical and Dental University Hospital of Medicine Tokyo Japan
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Zeng S, Chen D, Liu G, Wu YX, Gao ZQ, Su Y, Yuan JN, Liu L, Shan JC, Pang QF, Zhu T. Salvinorin A protects against methicillin resistant staphylococcus aureus-induced acute lung injury via Nrf2 pathway. Int Immunopharmacol 2020; 90:107221. [PMID: 33293260 DOI: 10.1016/j.intimp.2020.107221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 02/05/2023]
Abstract
Salvinorin A (SA), a neoclerodane diterpene, is isolated from the dried leaves ofSalvia divinorum. SA has traditionally been used treatments for chronic pain diseases. Recent research has demonstrated that SA possesses the anti-inflammatory property. The present study aim to explore the effects and potentialmechanisms ofSA in protection against Methicillin Resistant Staphylococcus aureus (MRSA)-induced acute lung injury (ALI). Here, we firstly found that verylowdosesof SA (50 μg/kg) could markedly decrease the infiltration of pulmonary neutrophils, mRNA expression of pro-inflammatory cytokines (TNF-α, IL-1β and IL-6) and then attenuated ALI cause by MRSA infection in mice. In vitro findings revealed that SA attenuated lipoteichoicacid-induced apoptosis, inflammation and oxidative stress in RAW264.7 cells. Mechanism research revealed that SA increased both mRNA levels and protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and up-regulated mRNA expression of its downstream genes (HO-1, Gclm, Trx-1, SOD1 and SOD2). Additionally, Nrf2 knockout mice abolished the inhibitory effect of SA on neutrophil accumulation and oxidative stress in MRSA-induced ALI. In conclusion, SA attenuates MRSA-induced ALI via Nrf2 signaling pathways.
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Affiliation(s)
- Si Zeng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Dan Chen
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Gang Liu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ya-Xian Wu
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Zhi-Qi Gao
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Ying Su
- Library, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Jia-Ning Yuan
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Liu Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China; Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, China
| | - Jia-Chen Shan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qing-Feng Pang
- Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China.
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Wang FY, Fang B, Yu ZH, Shao JS, Wen WB, Zhou LX. Severe thoracic trauma caused left pneumonectomy complicated by right traumatic wet lung, reversed by extracorporeal membrane oxygenation support-a case report. BMC Pulm Med 2019; 19:30. [PMID: 30727998 PMCID: PMC6366044 DOI: 10.1186/s12890-019-0790-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Double lumen intubation and one-lung ventilation should be applied without delay in cases of traumatic main bronchial rupture. In most cases, when the patients' vital signs have been stabilized, the repair can be performed. However, when one-lung ventilation is complicated by traumatic wet lung, the mortality rate is likely to be much higher. CASE PRESENTATION In this case, the patient experienced a left main bronchial rupture, bilateral traumatic wet lung, and acute respiratory distress syndrome (ARDS) because of severe thoracic trauma. Though the patient was treated with intubation and mechanical ventilation (MV), his oxygenation was still not stable. Thus, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated; upon improvement of oxygenation, the patient received an exploratory thoracotomy. Unfortunately, the rupture proved to be irreparable, resulting in a total left pneumonectomy. As there was severe ARDS caused by trauma, ECMO and ultra-low tidal volume (VT) MV strategy (3 ml/kg) were utilized for lung protection post-op. ECMO was sustained up to the 10th day, and MV until the 20th day, post-operation. With the support of MV, ECMO and other comprehensive measures, the patient made a recovery. CONCLUSION V-V ECMO and ultra-low VT MV helped this thoracic trauma patient survive the lung edema period and prevented ventilator associated pneumonia (VAP). In extreme situations, with the support of ECMO, the tidal volume may be lowered to 3 ml/kg.
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Affiliation(s)
- Feng Yun Wang
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China
| | - Bin Fang
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China
| | - Zhi Hui Yu
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China
| | - Jing Song Shao
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China
| | - Wei Biao Wen
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China
| | - Li Xin Zhou
- Critical Care Medicine Department of The First People's Hospital of Foshan, Lingnan Avenue North 81, Shiwan, Chancheng, Foshan, 528000, China.
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Dalmedico M, Ramos D, Hinata P, Alves W, Carvalho C, Avila J. Prone position and extracorporeal membrane oxygenation in acute respiratory distress syndrome. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The acute respiratory distress syndrome is an inflammatory process originated by some pulmonary diseases, resulting in non-hydrostatic protein edema of the pulmonary parenchyma. The loss of the lung ability to eliminate carbon dioxide generates complications such as refractory hypoxemia, decreased alveolar dysplasia, increased complacency and hypercarbia. The treatment of acute respiratory distress syndrome, consist in measures to prevent lung diseases progression and optimize oxygenation. Objective: To identify, in the international scientific literature, cases or series of cases reporting the combined application of prone position and extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome, as well as the benefit of these rescue therapies. Method: This is a systematic review of case reports that show the benefit of combined therapies in the treatment of patients with acute respiratory distress syndrome. Results: From the research strategy and selection criteria were included 8 studies reporting 19 cases of patients with acute respiratory distress syndrome who received the combination of the two rescue therapies. All studies showed that extracorporeal membrane oxygenation was the primary intervention. There were no reports of adverse events. Conclusion: The combinations of therapies positively interfere on the prognosis of patients with acute respiratory distress syndrome, in addition to presenting no additional risks in terms of the occurrence of adverse events; however, the prone position should precede the extracorporeal membrane oxygenation as first-line intervention. PROSPERO Registration No. CRD42018093076
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