Intensive Care Unit, Centre Hospitalier Yves Le Foll, Saint-Brieuc, France.
Department of Anesthesia and Critical Care, Rennes University Hospital, Rennes, France.
Crit Care Med. 2023 Jan 1;51(1):36-46. doi: 10.1097/CCM.0000000000005714. Epub 2022 Nov 11.
Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS.
Retrospective analysis of a multicenter cohort.
Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible.
None.
All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.
Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.
俯卧位通气和静脉-静脉体外膜肺氧合（ECMO）都是急性呼吸窘迫综合征（ARDS）的有效治疗手段。联合应用这两种治疗方法是可行且安全的，但疗效尚不清楚。本研究的目的是评估俯卧位通气对因 COVID-19 所致 ARDS 而接受静脉-静脉 ECMO 治疗患者的潜在生存获益。
多中心队列的回顾性分析。
接受静脉-静脉 ECMO 治疗的患者，且满足以下条件：通过逆转录聚合酶链反应检测出严重急性呼吸综合征冠状病毒 2 阳性，或胸部 CT 检查符合诊断标准。
无。
纳入了所有因呼吸衰竭而接受静脉-静脉 ECMO 治疗、在 ECMO 治疗期间的俯卧位通气状态和院内死亡率已知的患者。在 41 家中心的 647 例患者中，有 517 例符合条件。患者的中位年龄为 55（47-61）岁，78%为男性，95%在 ECMO 置管前接受了俯卧位通气。置管后，364 例（70%）患者接受了俯卧位通气，153 例（30%）患者在整个 ECMO 治疗期间保持仰卧位。俯卧位通气组和仰卧位通气组的院内死亡率分别为 194（53%）例和 92（60%）例。ECMO 治疗期间的俯卧位通气与较低的院内死亡率独立相关（比值比=0.49[0.29-0.84]；p=0.010）。在 153 对倾向评分匹配的患者中，俯卧位通气组的死亡率为 49.7%，仰卧位通气组的死亡率为 60.1%（p=0.085）。仅考虑撤机时存活的患者，倾向评分匹配的俯卧位通气患者的死亡率显著低于未接受俯卧位通气的患者（22.4%比 37.8%；p=0.029）。
俯卧位通气可能对因 COVID-19 所致 ARDS 而接受静脉-静脉 ECMO 治疗的患者有益，但需要更多数据来得出明确结论。
