Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 01 2023
01 01 2023
Historique:
entrez:
15
12
2022
pubmed:
16
12
2022
medline:
20
12
2022
Statut:
ppublish
Résumé
Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS. Retrospective analysis of a multicenter cohort. Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible. None. All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients. Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.
Identifiants
pubmed: 36519982
doi: 10.1097/CCM.0000000000005714
pii: 00003246-202301000-00006
pmc: PMC9749944
doi:
Banques de données
ClinicalTrials.gov
['NCT04397588']
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
36-46Investigateurs
Olivier Fouquet
(O)
Marc Pierrot
(M)
Sidney Chocron
(S)
Guillaume Flicoteaux
(G)
Philippe Mauriat
(P)
Hadrien Roze
(H)
Alexandre Ouattara
(A)
Olivier Huet
(O)
Marc-Olivier Fischer
(MO)
Claire Alessandri
(C)
Raphel Bellaïche
(R)
Ophélie Constant
(O)
Quentin De Roux
(Q)
André Ly
(A)
Arnaud Meffert
(A)
Jean-Claude Merle
(JC)
Lucile Picard
(L)
Elena Skripkina
(E)
Thierry Folliguet
(T)
Nicolas Mongardon
(N)
Antonio Fiore
(A)
Nicolas D'ostrevy
(N)
Marie-Catherine Morgan
(MC)
Maxime Nguyen
(M)
Pierre-Grégoire Guinot
(PG)
Lucie Gaide-Chevronnay
(L)
Nicolas Terzi
(N)
Gwenhaël Colin
(G)
Olivier Fabre
(O)
Arash Astaneh
(A)
Justin Issard
(J)
Elie Fadel
(E)
Dominique Fabre
(D)
Antoine Girault
(A)
Iolande Ion
(I)
Jean Baptiste Menager
(JB)
Delphine Mitilian
(D)
Julien Guihaire
(J)
Olaf Mercier
(O)
Jacques Thes
(J)
Jerôme Jouan
(J)
Thibault Duburcq
(T)
Valentin Loobuyck
(V)
Sabrina Manganiello
(S)
Mouhammed Moussa
(M)
Agnes Mugnier
(A)
Natacha Rousse
(N)
Olivier Desebbe
(O)
Roland Henaine
(R)
Matteo Pozzi
(M)
Jean-Luc Fellahi
(JL)
Jean-Christophe Richard
(JC)
Zakaria Riad
(Z)
Laurent Papazian
(L)
Matthias Castanier
(M)
Charles Chanavaz
(C)
Cyril Cadoz
(C)
Sebastien Gette
(S)
Guillaume Louis
(G)
Erick Portocarrero
(E)
Philippe Gaudard
(P)
Kais Brini
(K)
Nicolas Bischoff
(N)
Antoine Kimmoun
(A)
Bruno Levy
(B)
Mathieu Mattei
(M)
Pierre Perez
(P)
Alexandre Bourdiol
(A)
Yannick Hourmant
(Y)
Pierre-Joachim Mahé
(PJ)
Bertrand Rozec
(B)
Mickaël Vourc'h
(M)
Stéphane Aubert
(S)
Florian Bazalgette
(F)
Claire Roger
(C)
Sophie Provenchere
(S)
Pierre Jaquet
(P)
Brice Lortat-Jacob
(B)
Pierre Mordant
(P)
Patrick Nataf
(P)
Juliette Patrier
(J)
Morgan Roué
(M)
Romain Sonneville
(R)
Alexy Tran-Dinh
(A)
Paul-Henri Wicky
(PH)
Charles Al Zreibi
(C)
Bernard Cholley
(B)
Yannis Guyonvarch
(Y)
Sophie Hamada
(S)
Claudio Barbanti
(C)
Anatole Harrois
(A)
Astrid Bertier
(A)
Jordi Matiello
(J)
Thomas Kerforne
(T)
Corentin Lacroix
(C)
Nicolas Brechot
(N)
Juliette Chommeloux
(J)
Alain Combes
(A)
Jean Michel Constantin
(JM)
Cosimo D'alessandro
(C)
Pierre Demondion
(P)
Alexandre Demoule
(A)
Martin Dres
(M)
Muriel Fartoukh
(M)
Guillaume Hekimian
(G)
Charles Juvin
(C)
Pascal Leprince
(P)
Guillaume Fadel
(G)
David Levy
(D)
Charles Edouard Luyt
(CE)
Marc Pineton de Chambrun
(MP)
Thibaut Schoell
(T)
Roxane Nicolas
(R)
Maud Jonas
(M)
Charles Vidal
(C)
Nicolas Allou
(N)
Salvatore Muccio
(S)
Dario Di Perna
(D)
Bruno Mourvillier
(B)
Vito-Giovanni Ruggieri
(VG)
Amedeo Anselmi
(A)
Karl Bounader
(K)
Yoann Launey
(Y)
Thomas Lebouvier
(T)
Alessandro Parasido
(A)
Florian Reizine
(F)
Philippe Seguin
(P)
Emmanuel Besnier
(E)
Dorothée Carpentier
(D)
Thomas Clavier
(T)
Anne Olland
(A)
Pierre-Emmanuel Falcoz
(PE)
Marion Villard
(M)
Fanny Bounes
(F)
François Labaste
(F)
Vincent Minville
(V)
Antoine Guillon
(A)
Yannick Fedun
(Y)
Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Guervilly received consultancy fees from Xenios FMC. Dr. Schmidt received consultancy fees from Getinge, Xenios FMC, and Drager. Dr. Lebreton reports lecture fees from Livanova and Abiomed. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Guérin C, Reignier J, Richard J-C, et al.: Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368:2159–2168
Scholten EL, Beitler JR, Prisk GK, et al.: Treatment of ARDS with prone positioning. Chest. 2017; 151:215–224
Barbaro RP, MacLaren G, Boonstra PS, et al.: Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization Registry. Lancet. 2020; 396:1071–1078
Petit M, Fetita C, Gaudemer A, et al.: Prone-positioning for severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med. 2022; 50:264–274
Guervilly C, Prud’homme E, Pauly V, et al.: Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: Time for a randomized trial? Intensive Care Med. 2019; 45:1040–1042
Rilinger J, Zotzmann V, Bemtgen X, et al.: Prone positioning in severe ARDS requiring extracorporeal membrane oxygenation. Crit Care. 2020; 24:397
Giani M, Martucci G, Madotto F, et al.: Prone positioning during venovenous extracorporeal membrane oxygenation in acute respiratory distress syndrome. A multicenter cohort study and propensity-matched analysis. Ann Am Thorac Soc. 2021; 18:495–501
Zaaqoq AM, Barnett AG, Griffee MJ, et al.: Beneficial effect of prone positioning during venovenous extracorporeal membrane oxygenation for coronavirus disease 2019. Crit Care Med. 2022; 50:275–285
Giani M, Rezoagli E, Guervilly C, et al.: Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: A pooled individual patient data analysis. Crit Care. 2022; 26:8
Papazian L, Schmidt M, Hajage D, et al.: 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. Intensive Care Med. 2022; 48:270–280
Poon WH, Ramanathan K, Ling RR, et al.: Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care. 2021; 25:292
Barbaro RP, MacLaren G, Boonstra PS, et al.: Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international Extracorporeal Life Support Organization Registry. Lancet. 2021; 398:1230–1238
Nesseler N, Fadel G, Mansour A, et al.: Extracorporeal membrane oxygenation for respiratory failure related to COVID-19: A nationwide cohort study. Anesthesiology. 2022; 136:732–748
Falcoz P-E, Monnier A, Puyraveau M, et al.: Extracorporeal membrane oxygenation for critically ill patients with COVID-19–related acute respiratory distress syndrome: Worth the effort? Am J Resp Crit Care. 2020; 202:460–463
Lebreton G, Schmidt M, Ponnaiah M, et al.: Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: A multicentre cohort study. Lancet Respir Med. 2021; 9:851–862
Garcia B, Cousin N, Bourel C, et al.: Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome. Crit Care. 2020; 24:428
Ye Z, Zhang Y, Wang Y, et al.: Chest CT manifestations of new coronavirus disease 2019 (COVID-19): A pictorial review. Eur Radiol. 2020; 30:4381–4389
Jäckel M, Rilinger J, Lang CN, et al.: Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: A single-center registry study. Artif Organs. 2020; 45:593–601
Yehya N, Harhay MO, Curley MAQ, et al.: Reappraisal of ventilator-free days in critical care research. Am J Resp Crit Care. 2019; 200:828–836
Lederer DJ, Bell SC, Branson RD, et al.: Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of respiratory, sleep, and critical care journals. Ann Am Thorac Soc. 2018; 16:22–28
Textor J, van der Zander B, Gilthorpe MS, et al.: Robust causal inference using directed acyclic graphs: The R package “dagitty.” Int J Epidemiol. 2017; 45:1887–1894
Massart N, Mansour A, Flecher E, et al.: Clinical benefit of extubation in patients on venoarterial extracorporeal membrane oxygenation. Crit Care Med. 2022; 50:760–769
Vail EA, Gershengorn HB, Wunsch H, et al.: Attention to immortal time bias in critical care research. Am J Resp Crit Care. 2021; 203:1222–1229
Guervilly C, Hraiech S, Gariboldi V, et al.: Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol. 2013; 80:307–313
Kimmoun A, Roche S, Bridey C, et al.: Prolonged prone positioning under VV-ECMO is safe and improves oxygenation and respiratory compliance. Ann Intensive Care. 2015; 5:35
Bellani G, Laffey JG, Pham T, et al.: Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016; 315:788–800
Schmidt M, Pham T, Arcadipane A, et al.: Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An international multicenter prospective cohort. Am J Resp Crit Care. 2019; 200:1002–1012
Schmidt M, Hajage D, Demoule A, et al.: Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: A prospective cohort study. Intensive Care Med. 2020; 47:60–73
Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, et al.: Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med. 2020; 46:2200–2211
Langer T, Brioni M, Guzzardella A, et al.: Prone position in intubated, mechanically ventilated patients with COVID-19: A multi-centric study of more than 1000 patients. Crit Care. 2021; 25:128
Papazian L, Munshi L, Guérin C: Prone position in mechanically ventilated patients. Intensive Care Med. 2022; 48:1062–1065
Group RC, Horby P, Lim WS, et al.: Dexamethasone in hospitalized patients with Covid-19. New Engl J Med. 2020; 384:693–704
Matthay MA, Aldrich JM, Gotts JE: Treatment for severe acute respiratory distress syndrome from COVID-19. Lancet Respir Med. 2020; 8:433–434