1. Early reapplication of prone position during venovenous ECMO for acute respiratory distress syndrome: a prospective observational study and propensity-matched analysis.
- Author
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Wang, Rui, Tang, Xiao, Li, Xuyan, Li, Ying, Liu, Yalan, Li, Ting, Zhao, Yu, Wang, Li, Li, Haichao, Li, Meng, Li, Hu, Tong, Zhaohui, and Sun, Bing
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ADULT respiratory distress syndrome treatment , *REPEATED measures design , *EXTRACORPOREAL membrane oxygenation , *PATIENT safety , *ADULT respiratory distress syndrome , *EARLY medical intervention , *RESEARCH funding , *T-test (Statistics) , *SURVIVAL rate , *LYING down position , *SCIENTIFIC observation , *PROBABILITY theory , *PAIRED comparisons (Mathematics) , *FISHER exact test , *LOGISTIC regression analysis , *CLINICAL trials , *DESCRIPTIVE statistics , *LUNGS , *MANN Whitney U Test , *CHI-squared test , *LONGITUDINAL method , *CONTROL groups , *PRE-tests & post-tests , *KAPLAN-Meier estimator , *LOG-rank test , *STATISTICS , *VENTILATOR weaning , *PATIENT monitoring , *COMPARATIVE studies , *DATA analysis software , *COVID-19 pandemic , *PARTIAL pressure , *RESPIRATORY mechanics , *NONPARAMETRIC statistics - Abstract
Background: A combination of prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe, feasible, and associated with potentially improved survival for severe acute respiratory distress syndrome (ARDS). However, whether ARDS patients, especially non-COVID-19 patients, placed in PP before VV-ECMO should continue PP after a VV-ECMO connection is unknown. This study aimed to test the hypothesis that early use of PP during VV-ECMO could increase the proportion of patients successfully weaned from ECMO support in severe ARDS patients who received PP before ECMO. Methods: In this prospective observational study, patients with severe ARDS who were treated with VV-ECMO were divided into two groups: the prone group and the supine group, based on whether early PP was combined with VV-ECMO. The proportion of patients successfully weaned from VV-ECMO and 60-day mortality were analyzed before and after propensity score matching. Results: A total of 165 patients were enrolled, 50 in the prone and 115 in the supine group. Thirty-two (64%) and 61 (53%) patients were successfully weaned from ECMO in the prone and the supine groups, respectively. The proportion of patients successfully weaned from VV-ECMO in the prone group tended to be higher, albeit not statistically significant. During PP, there was a significant increase in partial pressure of arterial oxygen (PaO2) without a change in ventilator or ECMO settings. Tidal impedance shifted significantly to the dorsal region, and lung ultrasound scores significantly decreased in the anterior and posterior regions. Forty-five propensity score-matched patients were included in each group. In this matched sample, the prone group had a higher proportion of patients successfully weaned from VV-ECMO (64.4% vs. 42.2%; P = 0.035) and lower 60-day mortality (37.8% vs. 60.0%; P = 0.035). Conclusions: Patients with severe ARDS placed in PP before VV-ECMO should continue PP after VV-ECMO support. This approach could increase the probability of successful weaning from VV-ECMO. Trial Registration: ClinicalTrials.Gov: NCT04139733. Registered 23 October 2019. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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