Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS
Author:
Schmidt Matthieu123, Hajage David4, Lebreton Guillaume15, Dres Martin36, Guervilly Christophe7, Richard Jean Christophe8, Sonneville Romain9, Winiszewski Hadrien10, Muller Gregoire11, Beduneau Gaëtan12, Mercier Emmanuelle13, Roze Hadrien14, Lesouhaitier Mathieu15, Terzi Nicolas16, Thille Arnaud W.17, Laurent Isaura4, Kimmoun Antoine18, Combes Alain123, Luyt Charles Edouard19, Hekimian Guillaume19, Brechot Nicolas19, Chommeloux Juliette19, Pineton de Chambrun Marc19, Saura Ouriel19, Levy David19, Lefevre Lucie19, Assouline Benjamin19, Bahroum Petra19, Gautier Melchior19, Leprince Pascal19, Juvin Charles19, Demondion Pierre19, Bergue Elodie19, Danial Pichoy19, Al-kabani Hamed19, Bounader Karl19, Schoell Thibaut19, D'Allesandro Cosimo19, Bureau Côme19, Le Marec Julien19, Mayaux Julien19, Decavèle Maxens19, Demoule Alexandre19, Deleris Robin19, Nemlaghi Safaa19, Lecronier Marie19, Capellier Gilles19, Piton Gael19, Belon Francois19, Vieille Thibault19, Lafay Valentin19, Manfait Camille19, Tapponnier Romain19, Belin Nicolas19, Gacouin Arnaud19, Tadié Jean-Marc19, Papazian Laurent19, Hraiech Sami19, Forel Jean-Marie19, Roch Antoine19, Adda Mélanie19, Daviet Florence19, Gragueb-Chatti Ines19, Textoris Laura19, Timsit Jean-François19, Bouadma Lila19, de Montmollin Etienne19, Lamara Fariza19, Deiler Véronique19, Para Marylou19, Nataf Patrick19, Zmihi Sylia19, Wicky Paul Henri19, Patrier Juliette19, Jaquet Pierre19, Levy Bruno19, Perez Pierre19, Thivilier Carine19, Mattei Mathieu19, Haddadi Clément19, Kozutski Matthieu19, Maureira Pablo19, Yonis Hodane19, Mezidi Medhi19, Chauvelot Louis19, Danjou William19, Dhelft Francois19, Bitker Laurent19, Bettinger Clotilde19, Bernon Pauline19, Jolly Grégoire19, Carpentier Dorothée19, Nay Mai-Anh19, Boulain Thierry19, Kamel Toukif19, Barbier Francois19, Bretagnol Anne19, Mathonnet Armelle19, Desgrouas Maxime19, Skarzynski Marie19, Repusseau Benjamin19, Sigaud Florian19, Rigault Guillaume19, Galerneau Louis-Marie19, Schwebel Carole19, Candille Clara19, Dartevel Anaïs19, Bougnaud Joanna19, Turbil Emanuele19, Ehrmann Stephan19, Garot Denis19, Salmon Charlotte19, Le Pape Sylvain19, Arrivé Francois19,
Affiliation:
1. Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France 2. Assistance Publique–Hôpitaux de Paris, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Paris, France 3. GRC 30 RESPIRE, Sorbonne Université, Paris, France 4. Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière–Charles Foix, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France 5. Assistance Publique–Hôpitaux de Paris, Thoracic and Cardiovascular Department, Hôpital Pitié-Salpêtrière, Paris France 6. Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), et Sorbonne Université, INSERM, UMRS-1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France 7. Médecine Intensive Réanimation, Hôpital Nord, AP-HM, Centre d’Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Marseille, France 8. Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France 9. Université Paris Cité, INSERM U1137, F-75018 Paris, APHP Nord, Service de Médecine Intensive Réanimation, Hôpital Bichat–Claude Bernard, Paris, France 10. Service de Médecine Intensive Réanimation, CHU Besançon, Besançon, France 11. Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France 12. Université Rouen Normandie, Normandie Université, GRHVN UR 3830, Medical Intensive Care Unit, Rouen University Hospital, Rouen, France 13. Service de Médecine Intensive Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France 14. Service d’Anesthésie Réanimation Thoraco-Abdominale, CMC Magellan, Hôpital, Haut Leveque, CHU de Bordeaux, INSERM 1045: Centre de Recherche Cardio-Thoracique, Université de Bordeaux, Pessac, France 15. CHU Rennes, Service de Maladies Infectieuses et Réanimation Médicale, Rennes, France 16. Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Inserm U1042, Grenoble, France 17. CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France 18. Université de Lorraine, CHRU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Service de Médecine Intensive-Réanimation, U1116, FCRIN-INICRCT, Nancy, France 19. for the PRONECMO Investigators, the REVA Network, and the International ECMO Network (ECMONet)
Abstract
ImportanceProne positioning may improve outcomes in patients with severe acute respiratory distress syndrome (ARDS), but it is unknown whether prone positioning improves clinical outcomes among patients with ARDS who are undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO) compared with supine positioning.ObjectiveTo test whether prone positioning vs supine positioning decreases the time to successful ECMO weaning in patients with severe ARDS supported by VV-ECMO.Design, Setting, and ParticipantsRandomized clinical trial of patients with severe ARDS undergoing VV-ECMO for less than 48 hours at 14 intensive care units (ICUs) in France between March 3, 2021, and December 7, 2021.InterventionsPatients were randomized 1:1 to prone positioning (at least 4 sessions of 16 hours) (n = 86) or to supine positioning (n = 84).Main Outcomes and MeasuresThe primary outcome was time to successful ECMO weaning within 60 days following randomization. Secondary outcomes included ECMO and mechanical ventilation–free days, ICU and hospital length of stay, skin pressure injury, serious adverse events, and all-cause mortality at 90-day follow-up.ResultsAmong 170 randomized patients (median age, 51 [IQR, 43-59] years; n = 60 women [35%]), median respiratory system compliance was 15.0 (IQR, 10.7-20.6) mL/cm H2O; 159 patients (94%) had COVID-19–related ARDS; and 164 (96%) were in prone position before ECMO initiation. Within 60 days of enrollment, 38 of 86 patients (44%) had successful ECMO weaning in the prone ECMO group compared with 37 of 84 (44%) in the supine ECMO group (risk difference, 0.1% [95% CI, −14.9% to 15.2%]; subdistribution hazard ratio, 1.11 [95% CI, 0.71-1.75]; P = .64). Within 90 days, no significant difference was observed in ECMO duration (28 vs 32 days; difference, −4.9 [95% CI, −11.2 to 1.5] days; P = .13), ICU length of stay, or 90-day mortality (51% vs 48%; risk difference, 2.4% [95% CI, −13.9% to 18.6%]; P = .62). No serious adverse events were reported during the prone position procedure.Conclusions and RelevanceAmong patients with severe ARDS supported by VV-ECMO, prone positioning compared with supine positioning did not significantly reduce time to successful weaning of ECMO.Trial RegistrationClinicalTrials.gov Identifier: NCT04607551
Publisher
American Medical Association (AMA)
Cited by
28 articles.
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