Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation*. Issue 1 (11th November 2022)

• Record Type: Journal Article
• Authors: Massart, Nicolas; Guervilly, Christophe; Mansour, Alexandre; Porto, Alizée; Flécher, Erwan; Esvan, Maxime; Fougerou, Claire; Fillâtre, Pierre; Duburcq, Thibault; Lebreton, Guillaume; Para, Marylou; Stephan, François; Hraiech, Sami; Ross, James T.; Schmidt, Matthieu; Vincentelli, André; Nesseler, Nicolas
• Other Names: Fouquet Olivier author non-byline.; Pierrot Marc author non-byline.; Chocron Sidney author non-byline.; Flicoteaux Guillaume author non-byline.; Mauriat Philippe author non-byline.; Roze Hadrien author non-byline.; Ouattara Alexandre author non-byline.; Huet Olivier author non-byline.; Fischer Marc-Olivier author non-byline.; Alessandri Claire author non-byline.; Bellaïche Raphel author non-byline.; Constant Ophélie author non-byline.; De Roux Quentin author non-byline.; Ly André author non-byline.; Meffert Arnaud author non-byline.; Merle Jean-Claude author non-byline.; Picard Lucile author non-byline.; Skripkina Elena author non-byline.; Folliguet Thierry author non-byline.; Mongardon Nicolas author non-byline.; Fiore Antonio author non-byline.; D'ostrevy Nicolas author non-byline.; Morgan Marie-Catherine author non-byline.; Nguyen Maxime author non-byline.; Guinot Pierre-Grégoire author non-byline.; Gaide-Chevronnay Lucie author non-byline.; Terzi Nicolas author non-byline.; Colin Gwenhaël author non-byline.; Fabre Olivier author non-byline.; Astaneh Arash author non-byline.; Issard Justin author non-byline.; Fadel Elie author non-byline.; Fabre Dominique author non-byline.; Girault Antoine author non-byline.; Ion Iolande author non-byline.; Menager Jean Baptiste author non-byline.; Mitilian Delphine author non-byline.; Guihaire Julien author non-byline.; Mercier Olaf author non-byline.; Thes Jacques author non-byline.; Jouan Jerôme author non-byline.; Duburcq Thibault author non-byline.; Loobuyck Valentin author non-byline.; Manganiello Sabrina author non-byline.; Moussa Mouhammed author non-byline.; Mugnier Agnes author non-byline.; Rousse Natacha author non-byline.; Desebbe Olivier author non-byline.; Henaine Roland author non-byline.; Pozzi Matteo author non-byline.; Fellahi Jean-Luc author non-byline.; Richard Jean-Christophe author non-byline.; Riad Zakaria author non-byline.; Papazian Laurent author non-byline.; Castanier Matthias author non-byline.; Chanavaz Charles author non-byline.; Cadoz Cyril author non-byline.; Gette Sebastien author non-byline.; Louis Guillaume author non-byline.; Portocarrero Erick author non-byline.; Gaudard Philippe author non-byline.; Brini Kais author non-byline.; Bischoff Nicolas author non-byline.; Kimmoun Antoine author non-byline.; Levy Bruno author non-byline.; Mattei Mathieu author non-byline.; Perez Pierre author non-byline.; Bourdiol Alexandre author non-byline.; Hourmant Yannick author non-byline.; Mahé Pierre-Joachim author non-byline.; Rozec Bertrand author non-byline.; Vourc'h Mickaël author non-byline.; Aubert Stéphane author non-byline.; Bazalgette Florian author non-byline.; Roger Claire author non-byline.; Provenchere Sophie author non-byline.; Jaquet Pierre author non-byline.; Lortat-Jacob Brice author non-byline.; Mordant Pierre author non-byline.; Nataf Patrick author non-byline.; Patrier Juliette author non-byline.; Roué Morgan author non-byline.; Sonneville Romain author non-byline.; Tran-Dinh Alexy author non-byline.; Wicky Paul-Henri author non-byline.; Al Zreibi Charles author non-byline.; Cholley Bernard author non-byline.; Guyonvarch Yannis author non-byline.; Hamada Sophie author non-byline.; Barbanti Claudio author non-byline.; Harrois Anatole author non-byline.; Bertier Astrid author non-byline.; Matiello Jordi author non-byline.; Kerforne Thomas author non-byline.; Lacroix Corentin author non-byline.; Brechot Nicolas author non-byline.; Chommeloux Juliette author non-byline.; Combes Alain author non-byline.; Constantin Jean Michel author non-byline.; D'alessandro Cosimo author non-byline.; Demondion Pierre author non-byline.; Demoule Alexandre author non-byline.; Dres Martin author non-byline.; Fartoukh Muriel author non-byline.; Hekimian Guillaume author non-byline.; Juvin Charles author non-byline.; Leprince Pascal author non-byline.; Fadel Guillaume author non-byline.; Levy David author non-byline.; Luyt Charles Edouard author non-byline.; de Chambrun Marc Pineton author non-byline.; Schoell Thibaut author non-byline.; Nicolas Roxane author non-byline.; Jonas Maud author non-byline.; Vidal Charles author non-byline.; Allou Nicolas author non-byline.; Muccio Salvatore author non-byline.; Di Perna Dario author non-byline.; Mourvillier Bruno author non-byline.; Ruggieri Vito-Giovanni author non-byline.; Anselmi Amedeo author non-byline.; Bounader Karl author non-byline.; Launey Yoann author non-byline.; Lebouvier Thomas author non-byline.; Parasido Alessandro author non-byline.; Reizine Florian author non-byline.; Seguin Philippe author non-byline.; Besnier Emmanuel author non-byline.; Carpentier Dorothée author non-byline.; Clavier Thomas author non-byline.; Olland Anne author non-byline.; Falcoz Pierre-Emmanuel author non-byline.; Villard Marion author non-byline.; Bounes Fanny author non-byline.; Labaste François author non-byline.; Minville Vincent author non-byline.; Guillon Antoine author non-byline.; Fedun Yannick author non-byline.;
• Is Part Of: Critical care medicine. Volume 51:Issue 1(2023)
• Page Start: 36
• Page End: 46
• Publication Date: 2022-11-11
• Subjects: acute respiratory distress syndrome -- critical care -- extracorporeal membrane oxygenation -- mechanical ventilation -- mortality -- prone position; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005714
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : OBJECTIVES: 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. DESIGN: Retrospective analysis of a multicenter cohort. PATIENTS: 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. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.