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.

中文翻译：

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俯卧位对接受静脉静脉体外膜肺氧合治疗急性呼吸窘迫综合征的成年患者生存的影响：系统评价和荟萃分析

目的

先前的研究支持静脉体外膜肺氧合 (vvECMO) 对提高严重急性呼吸窘迫综合征 (ARDS) 病例生存率的潜在功效。俯卧位 (PP) 已被证明可以改善中重度 ARDS 患者的预后。很少有研究和随机对照试验评估了 PP 在 ECMO 患者中的作用。

方法

我们进行了系统回顾和荟萃分析，检查俯卧位对接受 vvECMO 的 ARDS 患者生存率的影响。联系所有作者以获取原始文章中未提及的补充信息。主要目的是比较有 PP 的 vvECMO 患者与没有 PP 的 vvECMO 患者（对照）的 28 天生存率。

结果

共有 1836 名患者的 13 项研究符合纳入标准。PP 与 28 天生存率显着改善相关（PP 组 681 名患者中的 503 名幸存者 [74%; 95% CI 71-77] 与对照组 770 名患者中的 450 名幸存者 [58%, 95% CI 55–62]；RR 1.31 [95% CI 1.21–1.41]；I ² 22% [95% CI 0–62%]；P  < 0.0001)。在其他终点（60 天生存期、90 天生存期、ICU 生存期和医院生存期）方面，生存率也有所提高。相反，vvECMO PP 患者的机械通气持续时间增加（平均差异 11.4 天 [95% CI 9.2–13.5]；0.64 [95% CI 0.50–0.78]；I ² 8%；P  < 0.0001）。

结论

根据这项荟萃分析，在接受 vvECMO 的 ARDS 患者中使用俯卧位可以提高生存率。这种组合对生存的影响应在前瞻性随机对照试验中进行调查。