Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC.
Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
Crit Care Med. 2022 Feb 1;50(2):275-285. doi: 10.1097/CCM.0000000000005296.
The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome.
An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders.
Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry.
Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period.
None.
There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14-0.68).
Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
本研究旨在探讨 COVID-19 急性呼吸衰竭患者接受 venovenous 体外膜肺氧合（ECMO）支持时采用俯卧位对患者结局的影响。
一项 venovenous ECMO 患者的观察性研究。我们使用多状态生存模型来比较 ECMO 期间接受或不接受俯卧位治疗的患者结局，该模型纳入了俯卧位的动态变化，并对潜在混杂因素进行了调整。
参与 COVID-19 危重病护理联盟国际注册中心的 72 个国际机构。
2020 年 2 月 16 日至 2020 年 10 月 31 日期间接受 venovenous ECMO 支持的 COVID-19 患者。
无。
共有 72 家参与机构的 232 例 COVID-19 患者在研究期间接受 venovenous ECMO 支持。在开始 ECMO 之前，有 176 例（76%）患者接受俯卧位，在 ECMO 期间，有 67 例（29%）患者接受俯卧位。在 ECMO 俯卧组中，有 33%的患者存活至出院，而在 ECMO 仰卧组中，有 22%的患者存活至出院。ECMO 支持期间进行俯卧位与死亡率降低相关（风险比，0.31；95%CI，0.14-0.68）。
我们的研究强调，在 venovenous ECMO 支持难治性 COVID-19 相关急性呼吸窘迫综合征时采用俯卧位与降低死亡率相关。鉴于该研究为观察性研究，需要进行 venovenous ECMO 上俯卧位的随机对照试验来证实这些发现。
