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Multicenter Study
. 2023 Jan 1;51(1):36-46.
doi: 10.1097/CCM.0000000000005714. Epub 2022 Nov 11.

Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation

Nicolas Massart  1   2 , Christophe Guervilly  3 , Alexandre Mansour  2   4 , Alizée Porto  5 , Erwan Flécher  6 , Maxime Esvan  4 , Claire Fougerou  4 , Pierre Fillâtre  1 , Thibault Duburcq  7 , Guillaume Lebreton  8   9 , Marylou Para  10   11 , François Stephan  12 , Sami Hraiech  3 , James T Ross  13 , Matthieu Schmidt  8   14 , André Vincentelli  15 , Nicolas Nesseler  2   4   16 ; Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome Coronavirus 2 (ECMOSARS) Investigators
Collaborators, Affiliations
Multicenter Study

Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation

Nicolas Massart et al. Crit Care Med. .

Abstract

Objectives: Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS.

Design: Retrospective analysis of a multicenter cohort.

Patients: Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible.

Interventions: None.

Measurements and main results: All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.

Conclusions: Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.

Trial registration: ClinicalTrials.gov NCT04397588.

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Conflict of interest statement

Dr. Guervilly received consultancy fees from Xenios FMC. Dr. Schmidt received consultancy fees from Getinge, Xenios FMC, and Drager. Dr. Lebreton reports lecture fees from Livanova and Abiomed. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart. ECMO = extracorporeal membrane oxygenation, VV = venovenous.
Figure 2.
Figure 2.
Survival curves of the matched patient pairs. ECMO = extracorporeal membrane oxygenation.
See this image and copyright information in PMC

References

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    1. Barbaro RP, MacLaren G, Boonstra PS, et al. : Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization Registry. Lancet. 2020; 396:1071–1078 - PMC - PubMed
    1. Petit M, Fetita C, Gaudemer A, et al. : Prone-positioning for severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med. 2022; 50:264–274 - PubMed
    1. Guervilly C, Prud’homme E, Pauly V, et al. : Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: Time for a randomized trial? Intensive Care Med. 2019; 45:1040–1042 - PubMed

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