Your browser doesn't support javascript.
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.
Papazian, Laurent; Schmidt, Matthieu; Hajage, David; Combes, Alain; Petit, Matthieu; Lebreton, Guillaume; Rilinger, Jonathan; Giani, Marco; Le Breton, Camille; Duburcq, Thibault; Jozwiak, Mathieu; Wengenmayer, Tobias; Roux, Damien; Parke, Rachael; Loundou, Anderson; Guervilly, Christophe; Boyer, Laurent.
  • Papazian L; Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France. laurent.papazian@ap-hm.fr.
  • Schmidt M; 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. laurent.papazian@ap-hm.fr.
  • Hajage D; 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.
  • Combes A; 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.
  • Petit M; 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.
  • Lebreton G; 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.
  • Rilinger J; Sorbonne Université, INSERM UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.
  • Giani M; Department of Cardiovascular and Thoracic Surgery, Institut de Cardiologie, AP-HP Hôpital Pitié-Salpêtrière, 75013, Paris, France.
  • Le Breton C; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
  • Duburcq T; Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.
  • Jozwiak M; Department of Emergency and Intensive Care, School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Monza, Italy.
  • Wengenmayer T; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, Médecine Intensive Réanimation, 92700, Colombes, France.
  • Roux D; Faculté de Santé, Université de Paris, UFR de Médecine, 75006, Paris, France.
  • Parke R; CHU Lille, Médecine Intensive Réanimation, 59000, Lille, France.
  • Loundou A; CHU de Nice, Hôpital Archet 1, Médecine Intensive Réanimation, 06200, Nice, France.
  • Guervilly C; Equipe 2 CARRES, UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
  • Boyer L; Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.
Intensive Care Med ; 48(3): 270-280, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1813641
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]; I2 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]; I2 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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-021-06604-x

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-021-06604-x