Prone positioning before extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: A retrospective multicenter study.

Objective: To evaluate the clinical outcomes of patients with severe acute respiratory distress syndrome (ARDS) subjected to prone positioning before extracorporeal membrane oxygenation (ECMO).
Design: A retrospective analysis of a multicenter cohort was carried out.
Setting: Patients admitted to the Intensive Care Units of 11 hospitals in Korea.
Patients: Patients were divided into those who underwent prone positioning before ECMO (n=28) and those who did not (n=34).
Interventions: None.
Variables of Interest: Thirty-day mortality, ECMO weaning failure rate, mechanical ventilation weaning success rate, mechanical ventilation-free days at day 60.
Results: The prone group had lower median peak inspiratory pressure and lower median dynamic driving pressure before ECMO. Thirty-day mortality was 21% in the prone group and 41% in the non-prone group (p=0.098). The prone group also showed a lower ECMO weaning failure rate, and a higher mechanical ventilation weaning success rate and more mechanical ventilation-free days at day 60. In the non-prone group, median dynamic compliance marginally decreased shortly after ECMO, but no significant change was observed in the prone group.
Conclusions: Prone positioning before ECMO was not associated to increased mortality and tended to exert a protective effect.
(Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.)