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. 2022 Jan 6;26(1):8.
doi: 10.1186/s13054-021-03879-w.

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis

Marco Giani #  1   2 , Emanuele Rezoagli #  3 , Christophe Guervilly  4   5 , Jonathan Rilinger  6   7 , Thibault Duburcq  8 , Matthieu Petit  9 , Laura Textoris  4 , Bruno Garcia  8 , Tobias Wengenmayer  6   7 , Giacomo Grasselli  10   11 , Antonio Pesenti  10   11 , Alain Combes  9   12 , Giuseppe Foti  3   13 , Matthieu Schmidt  9   12 ; EuroPronECMO Investigators
Collaborators, Affiliations

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis

Marco Giani et al. Crit Care. .

Abstract

Background: Prone positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies.

Methods: We performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to "conventional" ECMO management (Supine group) in patients with severe ARDS.

Results: 889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42-1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p = 0.072).

Conclusions: In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.

Keywords: Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Mortality; Pooled data analysis; Prone positioning.

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Conflict of interest statement

All authors declare no conflict of interest related to the submitted work. CG reports fees from Xenios Fresenus Medical Care; GG received personal fees (payment for lectures) and travel/congress registration support from Getinge, MSD, Draeger Medical and Fisher & Paykel; MS reported personal fees from Getinge, Drager, and Xenios, all unrelated with the present work.

Figures

Fig.1
Fig.1
Survival estimation over 60-day follow-up in matched groups of patients. For each time interval, the survival probability was calculated as the number of alive subjects divided by the number of patients at risk
Fig.2
Fig.2
Post-hoc analysis on risk of hospital mortality of patients who underwent prone positioning (PP) during ECMO versus patients managed in supine position (control) in predefined clinically relevant subgroups. Risk of hospital mortality was expressed using OR (points) with 95% CI (error bars) adjusted by robust clustering taking into account the 5 original cohorts of ECMO patients (i.e. clusters). BMI, Body Mass Index; SOFA, Sequential Organ Failure Assessment; MV, mechanical ventilation
See this image and copyright information in PMC

Comment in

References

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