nach oben

Erschienen in:

17.01.2022 | 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

verfasst von: 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

Erschienen in: Intensive Care Medicine | Ausgabe 3/2022

Einloggen, um Zugang zu erhalten

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.

Nur mit Berechtigung zugänglich

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

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

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

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

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

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

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

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

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.

Petit M, Fetita C, Gaudemer A, Treluyer L, Lebreton G, Franchineau G, Hekimian G, Chommeloux J, Pineton de Chambrun M, Brechot N, Luyt CE, Combes A, Schmidt M (2021) Prone-positioning for severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med. https://doi.org/10.1097/CCM.0000000000005145CrossRefPubMedCentral

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.

Higgins JP, Thomas J (2021) Cochrane handbook for systematic reviews of interventions. https://training.cochrane.org/handbook/current. Accessed 4 Jan 2022

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.

Team RDC (2021) The R project for statistical computing. https://www.r-project.org/. Accessed 4 Jan 2022

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

Titel: 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
verfasst von: 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
Publikationsdatum: 17.01.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 3/2022
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06604-x

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

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