• Marco Giani, Emanuele Rezoagli, Christophe Guervilly, Jonathan Rilinger, Thibault Duburcq, Matthieu Petit, Laura Textoris, Bruno Garcia, Tobias Wengenmayer, Giacomo Bellani, Giacomo Grasselli, Antonio Pesenti, Alain Combes, Giuseppe Foti, Matthieu Schmidt, and European Prone positioning During Extracorporeal Membrane Oxygenation (EuroPronECMO) Investigators.
• School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
• Crit. Care Med. 2023 Jan 1; 51 (1): 253525-35.

ObjectivesTo assess the association of timing to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) with the probability of being discharged alive from the ICU at 90 days (primary endpoint) and the improvement of the respiratory system compliance (Cpl,rs).DesignPooled individual data analysis from five original observational cohort studies.SettingEuropean extracorporeal membrane oxygenation (ECMO) centers.PatientsAcute respiratory distress syndrome (ARDS) patients who underwent PP during ECMO.InterventionsNone.Measurements And Main ResultsTime to PP during V-V ECMO was explored both as a continuous and a categorical variable with Cox proportional hazard models. Three hundred patients were included in the analysis. The longer the time to PP during V-V ECMO, the lower the adjusted probability of alive ICU discharge (adjusted hazard ratio [HR] 0.90 for each day increase; 95% CI, 0.87-0.93). Two hundred twenty-three and 77 patients were included in the early PP (≤ 5 d) and late PP (> 5 d) groups, respectively. The cumulative 90-day probability of being discharged alive from the ICU was 61% in the early PP group vs 36% in the late PP group (log-rank test, p <0.001). This benefit was maintained after adjustment for confounders (adjusted HR, 2.52; 95% CI, 1.66-3.81; p <0.001). In the early PP group, PP was associated with a significant improvement of Cpl,rs (4 ± 9 mL/cm H2O vs 0 ± 12 in the late PP group, p=0.038).ConclusionsIn a large cohort of ARDS patients on ECMO, early PP during ECMO was associated with a higher probability of being discharged alive from the ICU at 90 days and a greater improvement of Cpl,rs.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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