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

Critical Care

Antonio Pesenti¹  Giacomo Grasselli¹  Jonathan Rilinger²  Tobias Wengenmayer²  Laura Textoris³  Christophe Guervilly⁴  Emanuele Rezoagli⁵  Giuseppe Foti⁶  Marco Giani⁶  Bruno Garcia⁷  Thibault Duburcq⁷  Matthieu Petit⁸  Alain Combes⁹  Matthieu Schmidt⁹ 

[1] Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy;Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy;Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany;Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany;Medical Intensive Care, Unit North Hospital, APHM, Marseille, France;Medical Intensive Care, Unit North Hospital, APHM, Marseille, France;CER- eSS, Center for Studies and Research On Health Services and Quality of Life EA3279, Aix-Marseille University, Marseille, France;School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy;School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy;Department of Emergency and Intensive Care, ASST Monza, Monza, Italy;Service de Médecine Intensive-Réanimation, CHU Lille, 59000, Lille, France;Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié– Salpêtrière, Paris, France;Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié– Salpêtrière, Paris, France;Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France;

关键词: Acute respiratory distress syndrome;    Extracorporeal membrane oxygenation;    Prone positioning;    Pooled data analysis;    Mortality;   

DOI  :  10.1186/s13054-021-03879-w

来源: Springer

【 摘 要 】

BackgroundProne 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.MethodsWe 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.Results889 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).ConclusionsIn 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.

【 授权许可】

CC BY