Efficacy and safety of prone positioning in patients undergoing extracorporeal membrane oxygenation (ECMO): A systematic review and meta-analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-03-04 DOI:10.1016/j.jclinane.2025.111786

Po-Huang Chen M.D , Cho-Hao Lee M.D , Wei-Ting Yen M.D , Chiao-Chin Lee M.D , Hong-Jie Jhou M.D , Chen-Shu Wu M.D , Wen-Yu Lin M.D

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引用次数: 0

Abstract

Background

Acute respiratory distress syndrome (ARDS) is a severe lung condition characterized by diffuse alveolar damage and hypoxemia. Venovenous extracorporeal membrane oxygenation (vv-ECMO) supports gas exchange and reduces ventilator-induced injury, while prone positioning (PP) improves oxygenation by optimizing ventilation-perfusion matching.

Methods

We conducted a systematic review and meta-analysis, following PRISMA guidelines, using MEDLINE, Embase, and the Cochrane Library. Studies included were on adult ARDS patients undergoing vv-ECMO with PP. Outcomes measured were survival rates, ECMO weaning, duration of ECMO support, mechanical ventilation, ICU and hospital stays, and complications.

Results

Seventeen studies met inclusion criteria. While ECMO+PP improved 30-day and hospital survival rates, there was no significant improvement in 60-day survival, 90-day survival, ICU survival, or ECMO weaning rates. ECMO+PP significantly enhanced oxygenation parameters and reduced PaCO2 levels. Earlier and more frequent PP sessions shortened mechanical ventilation and ICU stays. Non-COVID patients had better 30-day survival with ECMO+PP than COVID patients.

Conclusions

Combining PP with ECMO improves early but not long-term survival in severe ARDS, especially in non-COVID patients, while extending duration of mechanical support and stays. Further prospective randomized trials are needed to confirm these findings.

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俯卧位在体外膜氧合（ECMO）患者中的疗效和安全性：一项系统综述和荟萃分析

背景：急性呼吸窘迫综合征（ARDS）是一种以弥漫性肺泡损伤和低氧血症为特征的严重肺部疾病。静脉-静脉体外膜氧合（vv-ECMO）支持气体交换，减少呼吸机引起的损伤，而俯卧位（PP）通过优化通气-灌注匹配来改善氧合。方法遵循PRISMA指南，使用MEDLINE、Embase和Cochrane图书馆进行系统评价和荟萃分析。研究纳入了接受vv-ECMO合并PP的成年ARDS患者。测量的结果是生存率、ECMO脱机、ECMO支持持续时间、机械通气、ICU和住院时间以及并发症。结果17项研究符合纳入标准。虽然ECMO+PP提高了30天生存率和住院生存率，但60天生存率、90天生存率、ICU生存率或ECMO脱机率没有显著提高。ECMO+PP可显著提高氧合参数，降低PaCO2水平。更早和更频繁的PP疗程缩短了机械通气和ICU住院时间。非COVID患者ECMO+PP的30天生存率高于COVID患者。结论PP联合ECMO可延长机械支持时间和住院时间，但不能改善严重ARDS患者的早期生存，尤其是非covid患者。需要进一步的前瞻性随机试验来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.