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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2022

01-03-2022 | Acute Respiratory Distress-Syndrome | Systematic Review

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

Authors: 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, Laurent Boyer

Published in: Intensive Care Medicine | Issue 3/2022

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Abstract

Purpose

Previous 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.

Methods

We 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).

Results

Thirteen 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).

Conclusion

According 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.
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Literature
1.
Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A, Eolia Trial Group R, Ecmonet (2018) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 378:1965–1975CrossRef
2.
Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D, collaboration Ct (2009) Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351–1363CrossRef
3.
Munshi L, Del Sorbo L, Adhikari NKJ, Hodgson CL, Wunsch H, Meade MO, Uleryk E, Mancebo J, Pesenti A, Ranieri VM, Fan E (2017) Prone position for acute respiratory distress syndrome. A systematic review and meta-analysis. Ann Am Thorac Soc 14:S280–S288CrossRef
4.
Guerin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L, Group PS (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168CrossRef
5.
Guervilly C, Hraiech S, Gariboldi V, Xeridat F, Dizier S, Toesca R, Forel JM, Adda M, Grisoli D, Collart F, Roch A, Papazian L (2014) Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol 80:307–313PubMed
6.
Kimmoun A, Roche S, Bridey C, Vanhuyse F, Fay R, Girerd N, Mandry D, Levy B (2015) Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance. Ann Intensive Care 5:35CrossRef
7.
Kipping V, Weber-Carstens S, Lojewski C, Feldmann P, Rydlewski A, Boemke W, Spies C, Kastrup M, Kaisers UX, Wernecke KD, Deja M (2013) Prone position during ECMO is safe and improves oxygenation. Int J Artif Organs 36:821–832CrossRef
8.
Giani M, Martucci G, Madotto F, Belliato M, Fanelli V, Garofalo E, Forlini C, Lucchini A, Panarello G, Bottino N, Zanella A, Fossi F, Lissoni A, Peroni N, Brazzi L, Bellani G, Navalesi P, Arcadipane A, Pesenti A, Foti G, Grasselli G (2021) Prone positioning during venovenous extracorporeal membrane oxygenation in acute respiratory distress syndrome. A multicenter cohort study and propensity-matched analysis. Ann Am Thorac Soc 18:495–501CrossRef
9.
Guervilly C, Prud’homme E, Pauly V, Bourenne J, Hraiech S, Daviet F, Adda M, Coiffard B, Forel JM, Roch A, Persico N, Papazian L (2019) Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: time for a randomized trial? Intensive Care Med 45:1040–1042CrossRef
10.
11.
Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRef
12.
13.
Fleiss JL (1993) The statistical basis of meta-analysis. Stat Methods Med Res 2:121–145CrossRef
14.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558CrossRef
15.
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560CrossRef
16.
Patsopoulos NA, Evangelou E, Ioannidis JP (2008) Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 37:1148–1157CrossRef
17.
Glasziou PP, Sanders SL (2002) Investigating causes of heterogeneity in systematic reviews. Stat Med 21:1503–1511CrossRef
18.
Thompson SG (1994) Why sources of heterogeneity in meta-analysis should be investigated. BMJ 309:1351–1355CrossRef
19.
Borenstein M, Higgins JP (2013) Meta-analysis and subgroups. Prev Sci 14:134–143CrossRef
20.
Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055CrossRef
21.
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634CrossRef
22.
23.
Schwarzer G (2007) Meta: an R package for meta-analysis. R News 7:40–45
24.
Chaplin H, McGuinness S, Parke R (2021) A single-centre study of safety and efficacy of prone positioning for critically ill patients on veno-venous extracorporeal membrane oxygenation. Aust Crit Care 34:446–451CrossRef
25.
Garcia B, Cousin N, Bourel C, Jourdain M, Poissy J, Duburcq T, C-g LIC (2020) Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome. Crit Care 24:428CrossRef
26.
Rilinger J, Zotzmann V, Bemtgen X, Schumacher C, Biever PM, Duerschmied D, Kaier K, Stachon P, von Zur MC, Zehender M, Bode C, Staudacher DL, Wengenmayer T (2020) Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation. Crit Care 24:397CrossRef
27.
Yang X, Hu M, Yu Y, Zhang X, Fang M, Lian Y, Peng Y, Wu L, Wu Y, Yi J, Zhang L, Wang B, Xu Z, Liu B, Yang Y, Xiang X, Qu X, Xu W, Li H, Shen Z, Yang C, Cao F, Liu J, Zhang Z, Li L, Liu X, Li R, Zou X, Shu H, Ouyang Y, Xu D, Xu J, Zhang J, Liu H, Qi H, Fan X, Huang C, Yu Z, Yuan S, Zhang D, Shang Y (2020) Extracorporeal membrane oxygenation for SARS-CoV-2 acute respiratory distress syndrome: a retrospective study from Hubei, China. Front Med (Lausanne) 7:611460CrossRef
28.
Jozwiak M, Chiche JD, Charpentier J, Ait Hamou Z, Jaubert P, Benghanem S, Dupland P, Gavaud A, Pene F, Cariou A, Mira JP, Nguyen LS (2020) Use of venovenous extracorporeal membrane oxygenation in critically-ill patients with COVID-19. Front Med (Lausanne) 7:614569CrossRef
29.
Network C-IGobotR (2021) Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 47:60–73CrossRef
30.
Le Breton C, Besset S, Freita-Ramos S, Amouretti M, Billiet PA, Dao M, Dumont LM, Federici L, Gaborieau B, Longrois D, Postel-Vinay P, Vuillard C, Zucman N, Lebreton G, Combes A, Dreyfuss D, Ricard JD, Roux D (2020) Extracorporeal membrane oxygenation for refractory COVID-19 acute respiratory distress syndrome. J Crit Care 60:10–12CrossRef
31.
Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, Baron E, Beurton A, Chommeloux J, Meng P, Nemlaghi S, Bay P, Leprince P, Demoule A, Guidet B, Constantin JM, Fartoukh M, Dres M, Combes A, Groupe de Recherche Clinique en ReSidPeIRaSU, Paris-Sorbonne E-Ci (2020) Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med 8:1121–1131CrossRef
32.
Lebreton G, Schmidt M, Ponnaiah M, Folliguet T, Para M, Guihaire J, Lansac E, Sage E, Cholley B, Megarbane B, Cronier P, Zarka J, Da Silva D, Besset S, Morichau-Beauchant T, Lacombat I, Mongardon N, Richard C, Duranteau J, Cerf C, Saiydoun G, Sonneville R, Chiche JD, Nataf P, Longrois D, Combes A, Leprince P, Paris E-C-i (2021) Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. Lancet Respir Med 9:851–862CrossRef
33.
Guerin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ, Munshi L, Papazian L, Pesenti A, Vieillard-Baron A, Mancebo J (2020) Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 46:2385–2396CrossRef
34.
Albert RK, Keniston A, Baboi L, Ayzac L, Guerin C, Proseva I (2014) Prone position-induced improvement in gas exchange does not predict improved survival in the acute respiratory distress syndrome. Am J Respir Crit Care Med 189:494–496CrossRef
35.
Poon WH, Ramanathan K, Ling RR, Yang IX, Tan CS, Schmidt M, Shekar K (2021) Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care 25:292CrossRef
Metadata
Title
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
Authors
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
Laurent Boyer
Publication date
01-03-2022
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 3/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-021-06604-x

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