Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis
Marco Giani,
Emanuele Rezoagli,
Christophe Guervilly,
Jonathan Rilinger,
Thibault Duburcq,
Matthieu Petit,
Laura Textoris,
Bruno Garcia,
Tobias Wengenmayer,
Giacomo Grasselli,
Antonio Pesenti,
Alain Combes,
Giuseppe Foti,
Matthieu Schmidt,
EuroPronECMO Investigators
Affiliations
Marco Giani
School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza
Emanuele Rezoagli
School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza
Christophe Guervilly
Medical Intensive Care, Unit North Hospital, APHM
Jonathan Rilinger
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg
Thibault Duburcq
Service de Médecine Intensive-Réanimation, CHU Lille
Matthieu Petit
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié– Salpêtrière
Laura Textoris
Medical Intensive Care, Unit North Hospital, APHM
Bruno Garcia
Service de Médecine Intensive-Réanimation, CHU Lille
Tobias Wengenmayer
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg
Giacomo Grasselli
Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Antonio Pesenti
Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Alain Combes
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié– Salpêtrière
Giuseppe Foti
School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza
Matthieu Schmidt
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne Université Hôpital Pitié– Salpêtrière
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.
