BMC Pulmonary Medicine (Jun 2022)

Effect of prone position in patients with acute respiratory distress syndrome supported by venovenous extracorporeal membrane oxygenation: a retrospective cohort study

  • Ziying Chen,
  • Min Li,
  • Sichao Gu,
  • Xu Huang,
  • Jingen Xia,
  • Qinghua Ye,
  • Jiangnan Zheng,
  • Qingyuan Zhan,
  • Chen Wang

DOI
https://doi.org/10.1186/s12890-022-02026-7
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 9

Abstract

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Abstract Background The application of prone position (PP) in acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO) is controversial. Objectives To evaluate the safety and efficacy of application of PP during VV-ECMO in patients with ARDS. Methods This was a single-center, retrospective study of patients who met the Berlin definition of ARDS, and were supported with VV-ECMO. We divided the patients into two groups. The prone group included patients who were supported by VV-ECMO, and experienced at least one period of PP, while those without PP during VV-ECMO were defined as the supine group. Propensity score matching (PSM) at a ratio of 1:1 was introduced to minimize potential confounders. The primary outcomes were the complications of PP and the change of arterial oxygen pressure/fraction of the inspiration (PaO2/FiO2) ratio after PP. The secondary outcomes were hospital survival, ICU survival, and ECMO weaning rate. Results From April 2013 to October 2020, a total of 91 patients met the diagnostic criteria of ARDS who were supported with ECMO. 38 patients (41.8%) received at least one period of PP during ECMO, while 53 patients (58.2%) were maintained in supine position during ECMO. 22 minor complications were reported in the prone group and major complications were not found. The other ECMO-related complications were similar between two groups. The PaO2/FiO2 ratio significantly improved after PP compared with before (174.50 (132.40–228.25) mmHg vs. 158.00 (122.93–210.33) mmHg, p < 0.001). PSM selected 25 pairs of patients with similar characteristics. Hospital survival or ICU survival did not differ between the two groups (40% vs. 28%, p = 0.370; 40% vs. 32%, p = 0.556). Significant difference of ECMO weaning rate between two groups was not found (56% vs. 32%, p = 0.087). Conclusions PP during VV-ECMO was safe and could improve oxygenation. A large-scale and well-designed RCT is needed in the future.

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