Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Cardiovascular Engineering

Background:

• Severe acute respiratory distress syndrome (ARDS) is a life-threatening condition.
• Prone positioning (PP) is known to improve survival in ARDS patients.
• The benefit of PP in ARDS patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) is not well-established.

Purpose of the Study:

• To investigate the efficacy of prone positioning (PP) in patients with severe ARDS receiving VV ECMO support.
• To determine if PP influences VV ECMO weaning success and hospital survival.

Main Methods:

• Retrospective analysis of a single-centre registry of severe ARDS patients on VV ECMO (October 2010 - May 2018).
• Patients were categorized into prone positioning (PP) and supine positioning groups.
• Propensity score matching was used to compare VV ECMO weaning rates and hospital survival.

Main Results:

• No significant difference in VV ECMO weaning rate or hospital survival was observed between the PP and supine groups.
• Propensity score matched analysis confirmed no difference in survival or weaning rates.
• Early initiation of PP (cutoff < 17 hours) was associated with significantly superior hospital survival (81.8% vs. 33.3%).

Conclusions:

• Prone positioning at any time during VV ECMO support for severe ARDS did not improve weaning or survival outcomes.
• Early initiation of prone positioning is crucial and significantly reduces hospital mortality in this patient population.