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Multicenter Study
. 2019 Oct;43(7):402-409.
doi: 10.1016/j.medin.2018.04.013. Epub 2018 Jul 6.

Prone positioning before extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: A retrospective multicenter study

[Article in English, Spanish]
W-Y Kim  1 , B J Kang  2 , C R Chung  3 , S H Park  4 , J Y Oh  5 , S Y Park  6 , W H Cho  7 , Y S Sim  8 , Y-J Cho  9 , S Park  10 , J-H Kim  11 , S-B Hong  12
Affiliations
Multicenter Study

Prone positioning before extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: A retrospective multicenter study

[Article in English, Spanish]
W-Y Kim et al. Med Intensiva (Engl Ed). 2019 Oct.

Abstract
in English, Spanish

Objective: To evaluate the clinical outcomes of patients with severe acute respiratory distress syndrome (ARDS) subjected to prone positioning before extracorporeal membrane oxygenation (ECMO).

Design: A retrospective analysis of a multicenter cohort was carried out.

Setting: Patients admitted to the Intensive Care Units of 11 hospitals in Korea.

Patients: Patients were divided into those who underwent prone positioning before ECMO (n=28) and those who did not (n=34).

Interventions: None.

Variables of interest: Thirty-day mortality, ECMO weaning failure rate, mechanical ventilation weaning success rate, mechanical ventilation-free days at day 60.

Results: The prone group had lower median peak inspiratory pressure and lower median dynamic driving pressure before ECMO. Thirty-day mortality was 21% in the prone group and 41% in the non-prone group (p=0.098). The prone group also showed a lower ECMO weaning failure rate, and a higher mechanical ventilation weaning success rate and more mechanical ventilation-free days at day 60. In the non-prone group, median dynamic compliance marginally decreased shortly after ECMO, but no significant change was observed in the prone group.

Conclusions: Prone positioning before ECMO was not associated to increased mortality and tended to exert a protective effect.

Objetivo: Evaluar los resultados clínicos de pacientes con síndrome de dificultad respiratoria aguda (SDRA) quienes fueron colocados en decúbito prono previo a la oxigenación con membrana extracorpórea (ECMO).

Diseño: Análisis retrospectivo de una cohorte multicéntrico.

Escenario: Pacientes admitidos en las unidades de cuidado intensivo de 11 hospitales en Corea.

Pacientes: Los pacientes fueron divididos en aquellos que fueron colocados en decúbito prono antes de la ECMO (n = 28) y aquellos que no fueron colocados en decúbito prono antes de la ECMO (n = 34).

Intervenciones: Ninguna.

Variables de interés principales: Mortalidad a los 30 días, tasa de fracaso de retirada gradual de la ECMO, tasa de éxito de retirada gradual de la ventilación mecánica, días sin ventilación mecánica a los 60 días.

Resultados: El grupo prono tuvo una mediana más baja de la presión inspiratoria máxima y una mediana más baja de la presión de conducción dinámica antes de la ECMO. La mortalidad a los 30 días fue 21% en el grupo prono y 41% en el grupo no prono (P = 0.098). El grupo prono también mostró un valor numérico menor de tasa de fracaso de retirada progresiva de la ECMO, y valores más altos de tasa de éxito de destete de la ventilación mecánica y días sin ventilación mecánica a los 60 días. En el grupo no prono, la mediana del cumplimiento dinámico descendió marginalmente, poco después de ECMO, pero no se observó un cambio significativo en el grupo prono.

Conclusiones: La colocación en decúbito prono antes de la ECMO no se asoció con un incremento en mortalidad y tendió a ser de protección.

Keywords: Decúbito prono; Extracorporeal membrane oxygenation; Oxigenación con membrana extracorpórea; Prone position; Respiración, artificial; Respiration, artificial; Respiratory distress syndrome, adult; Síndrome de dificultad respiratoria, adulto.

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Figures

Figure 1
Figure 1
Study flow diagram. ECMO: extracorporeal membrane oxygenation; BTT: bridge to transplant; ARDS: acute respiratory distress syndrome.
Figure 2
Figure 2
Kaplan–Meier survival curves of the study patients. ECMO: extracorporeal membrane oxygenation.
Figure 3
Figure 3
Effect of prone positioning before ECMO on dynamic compliance during a 24-h study period. Boxplots show median, 25th and 75th percentiles. Whiskers show 5th and 95th percentiles. aP = 0.06 vs. pre-ECMO. ECMO: extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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