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.

中文翻译：

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静脉体外膜氧合期间俯卧位对 2019 年冠状病毒病的有益作用*

 目标：

该研究调查了2019冠状病毒病急性呼吸衰竭的静脉体外膜氧合支持期间俯卧位对患者预后的影响。

 设计：

静脉体外膜肺氧合患者的观察性研究。我们使用多状态生存模型来比较在体外膜氧合期间采用或不采用俯卧位治疗的患者的结果，该模型结合了俯卧位的动态性质并针对潜在的混杂因素进行了调整。

 环境：

参与 2019 年冠状病毒病重症监护联盟国际登记的 72 家国际机构。

 患者：

研究期间接受静脉体外膜氧合支持的2019冠状病毒病患者。

 干涉：

 没有任何。

测量和主要结果：

在2020年2月16日至2020年10月31日的研究期间，72家参与机构的232名2019冠状病毒病患者接受了静脉体外膜肺氧合支持。176名患者（76%）在开始体外膜肺氧合前使用了俯卧撑氧合以及 67 名患者（29%）在体外膜氧合期间。体外膜氧合倾向组的出院生存率为 33%，而体外膜氧合仰卧组的出院生存率为 22%。体外膜肺氧合支持期间俯卧位与死亡率降低相关（风险比，0.31；95% CI，0.14-0.68）。

 结论：

我们的研究强调，在对 2019 年冠状病毒病相关的难治性急性呼吸窘迫综合征进行静脉-静脉体外膜氧合支持期间采取俯卧位，可降低死亡率。鉴于该研究的观察性质，需要对静脉体外膜氧合俯卧位进行随机对照试验来证实这些发现。