Prone positioning (PP) reduces mortality of patients with acute respiratory distress syndrome (ARDS). The potential benefit of prone positioning maneuvers during venovenous extracorporeal membrane oxygenation (ECMO) is unknown. The aim of this study was to evaluate the association between the use of prone positioning during extracorporeal support and ICU mortality in a pooled population of patients from previous European cohort studies. We performed a pooled individual patient data analysis of European cohort studies which compared patients treated with prone positioning during ECMO (Prone group) to “conventional” ECMO management (Supine group) in patients with severe ARDS. 889 patients from five studies were included. Unadjusted ICU mortality was 52.8% in the Supine Group and 40.8% in the Prone group. At a Cox multiple regression analysis PP during ECMO was not significantly associated with a reduction of ICU mortality (HR 0.67 95% CI: 0.42–1.06). Propensity score matching identified 227 patients in each group. ICU mortality of the matched samples was 48.0% and 39.6% for patients in the Supine and Prone group, respectively (p = 0.072). In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials.

中文翻译：

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急性呼吸窘迫综合征静脉静脉体外膜肺氧合期间的俯卧位：汇总的个体患者数据分析

俯卧位 (PP) 可降低急性呼吸窘迫综合征 (ARDS) 患者的死亡率。静脉体外膜肺氧合 (ECMO) 期间俯卧位操作的潜在益处尚不清楚。本研究的目的是评估体外支持期间俯卧位的使用与以前欧洲队列研究的患者汇总人群的 ICU 死亡率之间的关联。我们对欧洲队列研究进行了汇总的个体患者数据分析，该研究比较了在 ECMO 期间接受俯卧位治疗的患者（俯卧组）与严重 ARDS 患者的“常规” ECMO 管理（仰卧组）。包括来自五项研究的 889 名患者。仰卧组未经调整的 ICU 死亡率为 52.8%，俯卧组为 40.8%。在 Cox 多元回归分析中，ECMO 期间的 PP 与 ICU 死亡率的降低没有显着相关性（HR 0.67 95% CI：0.42-1.06）。倾向评分匹配确定了每组 227 名患者。仰卧组和俯卧组患者匹配样本的 ICU 死亡率分别为 48.0% 和 39.6% (p = 0.072)。在接受静脉静脉体外支持的大量 ARDS 患者中，在 ECMO 期间使用俯卧位与降低 ICU 死亡率没有显着相关性。该程序的影响必须通过前瞻性随机对照试验进行明确评估。仰卧组和俯卧组患者分别为 0% 和 39.6% (p = 0.072)。在接受静脉静脉体外支持的大量 ARDS 患者中，在 ECMO 期间使用俯卧位与降低 ICU 死亡率没有显着相关性。该程序的影响必须通过前瞻性随机对照试验进行明确评估。仰卧组和俯卧组患者分别为 0% 和 39.6% (p = 0.072)。在接受静脉静脉体外支持的大量 ARDS 患者中，在 ECMO 期间使用俯卧位与降低 ICU 死亡率没有显着相关性。该程序的影响必须通过前瞻性随机对照试验进行明确评估。