• Marco Giani, Emanuele Rezoagli, Christophe Guervilly, Jonathan Rilinger, Thibault Duburcq, Matthieu Petit, Laura Textoris, Bruno Garcia, Tobias Wengenmayer, Giacomo Grasselli, Antonio Pesenti, Alain Combes, Giuseppe Foti, Matthieu Schmidt, and EuroPronECMO Investigators.
• School of Medicine and Surgery, University of Milano-Bicocca, ASST Monza, Rianimazione generaleVia Pergolesi 33, 20900, Monza, Italy. marco.giani@unimib.it.
• Crit Care. 2022 Jan 6; 26 (1): 8.

BackgroundProne positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies.MethodsWe performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to "conventional" ECMO management (Supine group) in patients with severe ARDS.Results889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42-1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p = 0.072).ConclusionsIn a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.© 2022. The Author(s).

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