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. 2023 Jun 8;12(12):3918.
doi: 10.3390/jcm12123918.

Response to Prone Position in COVID-19 and Non-COVID-19 Patients with Severe ARDS Supported by vvECMO

Laura Textoris  1 , Ines Gragueb-Chatti  1 , Florence Daviet  1 , Sabine Valera  1 , Céline Sanz  1 , Laurent Papazian  1   2 , Jean-Marie Forel  1   3 , Sami Hraiech  1   3 , Antoine Roch  1   3 , Christophe Guervilly  1   3
Affiliations

Response to Prone Position in COVID-19 and Non-COVID-19 Patients with Severe ARDS Supported by vvECMO

Laura Textoris et al. J Clin Med. .

Abstract

Background: For moderate to severe acute respiratory distress syndrome (ARDS), lung-protective ventilation combined with prolonged and repeated prone position (PP) is recommended. For the most severe patients for whom this strategy failed, venovenous extracorporeal membrane oxygenation (vv-ECMO) allows a reduction in ventilation-induced lung injury and improves survival. Some aggregated data have suggested a benefit regarding survival in pursuing PP during vv-ECMO. The combination of PP and vv-ECMO has been also documented in COVID-19 studies, although there is scarce evidence concerning respiratory mechanics and gas exchange response. The main objective was to compare the physiological response of the first PP during vv-ECMO in two cohorts of patients (COVID-19-related ARDS and non-COVID-19 ARDS) regarding respiratory system compliance (CRS) and oxygenation changes.

Methods: This was a single-center, retrospective, and ambispective cohort study in the ECMO center of Marseille, France. ECMO was indicated according to the EOLIA trial criteria.

Results: A total of 85 patients were included, 60 in the non-COVID-19 ARDS group and 25 in the COVID-19-related ARDS group. Lung injuries of the COVID-19 cohort exhibited significantly higher severity with a lower CRS at baseline. Concerning the main objective, the first PP during vv-ECMO was not associated with a change in CRS or other variation in respiratory mechanic variables in both cohorts. By contrast, oxygenation was improved only in the non-COVID-19 ARDS group after a return to the supine position. Mean arterial pressure was higher during PP as compared with a return to the supine position in the COVID-19 group.

Conclusion: We found distinct physiological responses to the first PP in vv-ECMO-supported ARDS patients according to the COVID-19 etiology. This could be due to higher severity at baseline or specificity of the disease. Further investigations are warranted.

Keywords: COVID-19; prone position; respiratory system compliance; severe ARDS; venovenous ECMO.

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Conflict of interest statement

Christophe Guervilly reports personal consulting fees from Xenios FMC outside the submitted work. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Variation in respiratory mechanics parameters during the first PP under vv-ECMO in patients with COVID-19 ARDS. The empty circles represent the outliers and the black stars represent the extreme values.
Figure 2
Figure 2
Variation in gas exchange during the first prone positioning under vv-ECMO for COVID-19 ARDS.
See this image and copyright information in PMC

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