Abstract
BackgroundProne positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is also beneficial for ARDS patients treated with veno-venous extracorporeal membrane oxygenation (VV ECMO) support.MethodsWe report retrospective data of a single-centre registry of patients with severe ARDS requiring VV ECMO support between October 2010 and May 2018. Patients were allocated to the PP group if PP was performed during VV ECMO treatment or the supine positioning group. VV ECMO weaning success and hospital survival were analysed before and after propensity score matching.ResultsA total of 158 patients could be analysed, and 38 patients (24.1%) received PP. There were no significant differences in VV ECMO weaning rate (47.4% vs. 46.7%, p = 0.94) and hospital survival (36.8% vs. 36.7%, p = 0.98) between the prone and supine groups, respectively. The analysis of 38 propensity score matched pairs also showed no difference in hospital survival (36.8% vs. 36.8%, p = 1.0) or VV ECMO weaning rate (47.4% vs. 44.7%, p = 0.82). Hospital survival was superior in the subgroup of patients treated with early PP (cutoff < 17 h via Youden’s Index) as compared to late or no PP (81.8% vs. 33.3%, p = 0.02).ConclusionIn this propensity score matched cohort of severe ARDS patients requiring VV ECMO support, prone positioning at any time was not associated with improved weaning or survival. However, early initiation of prone positioning was linked to a significant reduction of hospital mortality.
Highlights
Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS)
We report retrospective data of a single-centre registry of patients with severe ARDS treated with VV Extracorporeal membrane oxygenation (ECMO)
Patients with PP during ECMO support had a higher rate of pre-existing chronic renal failure and pneumoniainduced ARDS
Summary
Prone positioning (PP) has shown to improve survival in patients with severe acute respiratory distress syndrome (ARDS). To this point, it is unclear if PP is beneficial for ARDS patients treated with venovenous extracorporeal membrane oxygenation (VV ECMO) support. In case of severe acute respiratory distress syndrome (ARDS), veno-venous extracorporeal membrane oxygenation (VV ECMO) support may be considered when. Several studies showed that prone positioning (PP) is able to improve survival in these critically ill patients [4, 5]. It has been demonstrated that PP can be performed safely [9,10,11,12,13] during ECMO support and improves oxygenation and lung compliance [14]. We performed a retrospective analysis of ARDS patients treated with PP during ECMO support at our centre
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