A single-centre study of safety and efficacy of prone positioning for critically ill patients on veno-venous extracorporeal membrane oxygenation

Abstract

BackgroundVeno-venous extracorporeal membrane oxygenation (VV-ECMO) may be used for patients with severe respiratory failure. Prone positioning may also be worthwhile using while patients are on VV-ECMO to promote return of native lung function. ObjectivesThe aim of the study was to determine if the use of prone positioning in adult patients receiving VV-ECMO improved oxygenation, shortened the time on ECMO, and led to earlier liberation from ECMO compared with no prone positioning. We also wished to determine the incidence of pressure injury development in patients receiving prone positioning. MethodsThis was a single-centre, retrospective cohort study of patients on VV-ECMO over 5 years at a national ECMO centre. FindingsBetween July 1, 2014, and July 1, 2019, 72 patients were admitted to the cardiothoracic and vascular intensive care unit for VV-ECMO owing to respiratory failure. Patients were aged on average 46 years, male (n = 46, 64%), and New Zealand Europeans (n = 45, 63%). The most common diagnosis was pneumonia, the median ECMO treatment duration was 278 h, and 50 patients (69%) of the cohort survived to 6 months. Of these, 16 (22%) received at least one pronation procedure whilst on ECMO. Pronation increased oxygenation ratio although not significantly, and this increase was not sustained once returned to the supine position. Pronation was instituted late in the ECMO course and was not associated with complications. Prone episodes were carried out in a safe manner with few adverse events or complications. ConclusionsIn patients requiring VV-ECMO support, prone positioning would appear to be a safe intervention when carried out by an experienced team.