OBJECTIVES: The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome. DESIGN: An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders. SETTING: Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry. PATIENTS: Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14–0.68). CONCLUSIONS: Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
Beneficial Effect of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019* / Zaaqoq, A.M. ; Barnett, A.G. ; Griffee, M.J. ; Maclaren, G. Jacobs, J.P. ; Heinsar, S. Suen, J.Y. ; Bassi, G. Li; Fraser, J.F. ; Dalton, H.J. ; Peek, G.J. ; Samuel Hinton, ;. Simon Forsyth, ;. Mauro Panigada, ;. John Laffey, ;. Daniel Brodie, ;. Eddy Fan, ;. Antoni Torres;; Davide Chiumello, ;. Amanda Corley, ;. India Pearse, ;. Alyaa Elhazmi; Carol Hodgson, ;. Shingo Ichiba, ;. Carlos Luna, ;. Srinivas Murthy, ;. Alistair Nichol, ;. Pauline Yeung Ng, ;. Mark Ogino, ;. Antonio Pesenti, ;. Huynh Trung Trieu, ;. Robert Bartlett, ;. Gabriella Abbate, ;. Ryuzo Abe, ;. Shingo Adachi, ;. Takako Akimoto, ;. Abdulrahman Al-Fares, ;. Huda Alfoudri, ;. Abdullah Al-Hudaib, ;. Massimo Antonelli, ;. Christel Arnold-Day, ;. Lovkesh Arora, ;. Michaela Barnikel, ;. Peter Barrett, ;. Aleksandr Beljantsev, ;. Suzanne Bennett, ;. Amar Bhatt, ;. Pablo Blanco-Schweizer, ;. Luca Brazzi, ;. Nicolas Brozzi, ;.S.F. Buabbas, ;. Nina Buchtele, ;. Erlina Burhan, ;. Hergen Buscher, ;. Aidan Burrell, M. Caroline, ;.E.G. Carton, ;.E.C. à Lvarez, ;. Adrian Ceccato, ;. Silvia Coppola, ;. Hwa Jin Cho, ;. Sung-Min Cho, M. Young-Jae Cho, ;. Anna Ciullo, S.M. Colombo, ;. Sofãa Contreras, ;. Alberto Cucino, ;. Al-Awwab M, Dabaliz, ;. Andrea Dell’Amore, ;. Mehul Desai, ;. Esther Dreier, ;. Lucian Durham, ;. Tarek B, El-Shazly, ;. Octavio Falcucci, ;. Shu Fang, ;. Arie Zainul Fatoni, ;. Mohamed Fayed, ;. Ricard Ferrer Roca, ;.K.M. Fiest, ;. Cathleen Forney, ;. Giuseppe Foti, ;. Shigeki Fujitani, ;. Masahiro Fukuda, ;. Sã©rgio Gaiã£o, ;. Johannes Gebauer, ;. Marco Giani, ;. Eric Gnall, ;. Jerã³nimo Graf, ;.E. Wilson Grandin, ;. Giacomo Grasselli, ;. Anna Greti, ;. Halah Hassan, ;. Ibrahim Hassan, ;. Jaime Hernandez-Montfort, ;. Kanako Horibe, ;. Koji Hoshino, ;. Kota Hoshino, ;. Ali Ait Hssain, ;. Jeffrey Javidfar, ;. In Seok Jeong, ;. Juan Masa Jimã©nez, ;. Anne Joosten, ;. Mark Joseph, ;. Jae-Seung Jung, ;. Ruth Noemã Jorge Garcãa, ;.V.A. Karnik, ;. Daisuke Kasugai, ;. Christy Kay, ;. Katrina Ki, ;. Irfan Khan, ;. Jae-Bum Kim, ;. Ethan Kurtzman, ;. Su Hwan Lee, ;. Keibun Liu, ;. Michela Leone, ;. Antonio Loforte, ;. Roberto Lorusso, ;. Gã¶sta Lotz, ;. Olavi Maasikas, ;. Lars Maier, ;. Maximilian Malfertheiner, ;. Angela Maria Marulanda Yantã©n, ;. Eva Marwali, ;. Danny Mcauley, ;. Colin Mccloskey, ;. Angela Mcbride, ;. Dan Meyer, ;. Brook Mitchell, ;.N.A. Mokadam, ;. Giorgia Montrucchio, ;. Rita Moreno, ;. Naoki Moriyama, ;. Andrea Moscatelli, ;. Ana Motos, ;. Paolo Navalesi, ;. Wing Yiu Ng, ;.H.F. O’Neill, ;. Nchafatso Obonyo, ;. Tawnya Ogston, ;. Getter Õigus, ;. Shinichiro Ohshimo, ;. Erik Osborn, ;. Javier Osatnik, ;. Clark Owyang, ;.K.K.S. Parhar, ;. Paolo Pelosi, ;. Leticia Pretti Pimenta, ;. Mohammed Abraar Quraishi, ;. Kollengode Ramanathan, ;. Indrek Rã¤tsep, ;.J.D. Reid, ;. Jordi Riera, ;. Diego Fernando Bautista Rincã³n, ;. Roberto Roncon-Albuquerque, ;. Kristina Rudolph, ;. Angel Sanchez, ;. Gabriele Sales, ;.S. Veena Satyapriya, ;. Kei Sato, ;. Stephan Schroll, ;. Michael Schwameis, ;. Tamara Seitz, ;. Timothy Shapiro, ;. Kiran Shekar, ;. Hiroaki Shimazu, ;. Naoki Shimizu, ;. Hoi-Ping Shum, ;. Malcolm Sim, Mbbch, ;. Dominic So, ;. Tae Song, ;.H.T. Stelfox, ;. Madhu Subramanian, ;. Stephanie-Susanne Stecher, ;. Subbarao Elapavaluru, ;. Konstanty Szuldrzynski, ;. Hiro Tanaka, ;. Hayato Taniguci, ;. Azhari Taufik, ;. Shaun Thompson, ;. David Thomson, ;. Yuka Uchinami, ;. Asad Ali Usman, ;. Jorge Velazco, ;. Aapeli Vuorinen, Bmath, ;.K.S.W.E.S. Wood; Masaki Yamasaki, ;. Minlan Yang, ;. Stephanie Yerkovich, ;. Toshiki Yokoyama, ;. Saptadi Yularito, ;. Ana Loza Vazquez, ;. Bishoy Zakhary, ;. Alberto Zanella, ;. Navy Long, ;. Vera Irawany, ;. Kohar Hari Santoso, ;. Susanthy Djajalaksana, ;. Gezy Giwangkancana, ;. Erwin Pradian, ;.J.M. Mandei, ;. Keiki Shimizu, ;. Nobuya Kitamura, ;. Simone Carelli, ;. Antonia Arcadipane, ;. Vincenzo Russotto, ;. Yuri Kida, Msw, J. Madhok; Terese Hammond, M. Epler, ;. Louise Kruse, ;. Ryan Kennedy, ;. Timothy Evans, ;. John Adam Reich, ;. David Dean, ;. Keith Wille, ;. Marc Csete; Glenn Whitman, ;. Michael Piagnerelli, ;. Patrick Biston, ;. Juan Fernando Masa Jimã©nez; Leonardo Salazar, ;. Rodrigo Diaz Gã³mez, ;. Josefa Valenzuela Sarrazin; Piotr BielaÅ„ski, M. Miller, ;. Lisa Seymore, ;. Mariano Esperatti, ;. Andrea Villoldo, ;.A. Dave Nagpal, ;.G.C.H.M.C. Dwyer.. - In: CRITICAL CARE MEDICINE. - ISSN 0090-3493. - 50:2(2022), pp. 275-285. [10.1097/ccm.0000000000005296]
Beneficial Effect of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019*
S.M. Colombo;
2022
Abstract
OBJECTIVES: The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome. DESIGN: An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders. SETTING: Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry. PATIENTS: Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14–0.68). CONCLUSIONS: Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
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