Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.

Laurent Papazian, Matthieu Schmidt, David Hajage, Alain Combes, Matthieu Petit, Guillaume Lebreton, Jonathan Rilinger, Marco Giani, Camille Le Breton, Thibault Duburcq, Mathieu Jozwiak, Tobias Wengenmayer, Damien Roux, Rachael Parke, Anderson Loundou, Christophe Guervilly, Laurent Boyer

Journal: Intensive care medicine 2022;48(3):270-280

PMID: 35037993

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Abstract

PURPOSE

Previous studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients.

METHODS

We performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not mentioned in the original articles. The main objective was to compare 28-day survival in vvECMO patients with PP to vvECMO patients without PP (controls).

RESULTS

Thirteen studies with a combined population of 1836 patients satisfied the inclusion criteria. PP was associated with a significant improvement in 28-day survival (503 survivors among 681 patients in the PP group [74%; 95% CI 71-77] vs. 450 survivors among 770 patients in the control group [58%, 95% CI 55-62]; RR 1.31 [95% CI 1.21-1.41]; I 22% [95% CI 0-62%]; P < 0.0001). Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival). In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP (mean difference 11.4 days [95% CI 9.2-13.5]; 0.64 [95% CI 0.50-0.78]; I 8%; P < 0.0001).

CONCLUSION

According to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO. The impact of this combination on survival should be investigated in prospective randomized controlled trials.

Address: Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France. [email protected].; Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France. [email protected].; Sorbonne Université, GRC 30, RESPIRE, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Médecine Intensive Réanimation, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France.; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, 75013, Paris, France.; Sorbonne Université, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.; Department of Cardiovascular and Thoracic Surgery, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France.; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.; Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.; Department of Emergency and Intensive Care, School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy.; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, 92700, Colombes, France.; Faculté de Santé, Université de Paris, UFR de Médecine, 75006, Paris, France.; CHU Lille, Médecine Intensive Réanimation, 59000, Lille, France.; CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France.; Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.; School of Nursing, The University of Auckland, Auckland, New Zealand.; CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.; Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France.; Aix-Marseille Université, Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005, Marseille, France.

DOI: 10.1007/s00134-021-06604-x

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MeSH Terms: Adult, Extracorporeal Membrane Oxygenation, Humans, Prone Position, Prospective Studies, Respiration, Artificial, Respiratory Distress Syndrome, Retrospective Studies