Prone Positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Multicenter Cohort Study and Propensity-matched Analysis
| Autor: | Fabiana Madotto, Antonio Arcadipane, Marco Giani, Alfredo Lissoni, Mirko Belliato, Antonio Pesenti, Alberto Lucchini, Giacomo Bellani, Luca Brazzi, Giuseppe Foti, Nicola Bottino, Giacomo Grasselli, Clarissa Forlini, Francesca Fossi, Eugenio Garofalo, Paolo Navalesi, Nicola Peroni, Gennaro Martucci, Giovanna Panarello, Vito Fanelli, Alberto Zanella |
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| Přispěvatelé: | 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 |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty ARDS medicine.medical_treatment Prone positioning Acute respiratory distress Extracorporeal 03 medical and health sciences 0302 clinical medicine mental disorders Extracorporeal membrane oxygenation medicine 030212 general & internal medicine Acute respiratory distress syndrome business.industry Oxygenation medicine.disease Prone position surgical procedures operative 030228 respiratory system Emergency medicine Propensity score matching ECMO business psychological phenomena and processes Cohort study |
| Zdroj: | Annals of the American Thoracic Society. 18:495-501 |
| ISSN: | 2325-6621 2329-6933 |
| DOI: | 10.1513/annalsats.202006-625oc |
| Popis: | Rationale: Prone positioning reduces mortality in patients with severe acute respiratory distress syndrome (ARDS). To date, no evidence supports the use of prone positioning (PP) during venovenous extracorporeal oxygenation (ECMO). Objectives: The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality. Methods: We performed a multicenter retrospective cohort study in six Italian ECMO centers, including patients managed with PP during ECMO support (prone group; four centers) and patients managed in the supine position (control group; two centers). Physiological variables were analyzed at four time points (supine before PP, start of PP, end of PP, and supine after PP). The association between PP and hospital mortality was assessed by multivariate analysis and propensity score–matching. Results: A total of 240 patients were included, with 107 in the prone group and 133 in the supine group. The median duration of the 326 pronation cycles was 15 (12–18) hours. Minor reversible complications were reported in 6% of PP maneuvers. PP improved oxygenation and reduced intrapulmonary shunt. Unadjusted hospital mortality was lower in the prone group (34 vs. 50%; P = 0.017). After adjusting for covariates, PP remained significantly associated with a reduction of hospital mortality (odds ratio, 0.50; 95% confidence interval, 0.29–0.87). Sixty-six propensity score–matched patients were identified in each group. In this matched sample, patients who underwent pronation had higher ECMO duration (16 vs. 10 d; P = 0.0344) but lower hospital mortality (30% vs. 53%; P = 0.0241). Conclusions: PP during ECMO improved oxygenation and was associated with a reduction of hospital mortality. |
| Databáze: | OpenAIRE |
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