• Intensive care medicine · Mar 2022

    Meta Analysis

    Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.

    • Laurent Papazian, Matthieu Schmidt, David Hajage, Alain Combes, Matthieu Petit, Guillaume Lebreton, Jonathan Rilinger, Marco Giani, Camille Le Breton, Thibault Duburcq, Mathieu Jozwiak, Tobias Wengenmayer, Damien Roux, Rachael Parke, Anderson Loundou, Christophe Guervilly, and Laurent Boyer.
    • Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, Hôpital Nord, Chemin Des Bourrely, 13015, Marseille, France. laurent.papazian@ap-hm.fr.
    • Intensive Care Med. 2022 Mar 1; 48 (3): 270-280.

    PurposePrevious studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients.MethodsWe performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not mentioned in the original articles. The main objective was to compare 28-day survival in vvECMO patients with PP to vvECMO patients without PP (controls).ResultsThirteen studies with a combined population of 1836 patients satisfied the inclusion criteria. PP was associated with a significant improvement in 28-day survival (503 survivors among 681 patients in the PP group [74%; 95% CI 71-77] vs. 450 survivors among 770 patients in the control group [58%, 95% CI 55-62]; RR 1.31 [95% CI 1.21-1.41]; I2 22% [95% CI 0-62%]; P < 0.0001). Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival). In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP (mean difference 11.4 days [95% CI 9.2-13.5]; 0.64 [95% CI 0.50-0.78]; I2 8%; P < 0.0001).ConclusionAccording to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO. The impact of this combination on survival should be investigated in prospective randomized controlled trials.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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