Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis

IF 27.1 1区医学 Q1 CRITICAL CARE MEDICINE

Intensive Care Medicine Pub Date : 2025-04-29 DOI:10.1007/s00134-025-07877-2

Tommaso Pettenuzzo, Eleonora Balzani, Nicolò Sella, Marco Giani, Mara Bassi, Valentina Fincati, Rossella Cescon, Giorgia Pacchiarini, Giovanna Pandolfo, Roberta Ceccato, Lars Grønlykke, Dawid L. Staudacher, Nicolas Nesseler, Senta Jorinde Raasveld, Michele Carron, Elisa Pistollato, Giulia Mormando, Francesco Zarantonello, Alessandro De Cassai, Annalisa Boscolo, Emanuele Rezoagli, Giuseppe Foti, Paolo Navalesi

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引用次数: 0

Abstract

Purpose

The evidence supporting the benefit on clinical outcomes of prone positioning during veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute hypoxemic respiratory failure remains inconclusive. We aimed to assess the association of prone positioning, compared to no prone positioning, with 28-day mortality and other clinical outcomes in different patient subgroups.

Methods

A systematic review and meta-analysis of randomized and non-randomized controlled trials (RCTs) using a random-effects model was conducted. An electronic database search up to September 1st, 2024 was performed (PROSPERO CRD42024517602). The RoB 2 and ROBINS-I tools were used for risk of bias assessments.

Results

We analyzed two RCTs and 20 non-RCTs (3,465 patients). Compared to no prone positioning, the use of prone positioning was associated with lower 28-day (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.42–0.98, p = 0.040, I² = 66%, low certainty of evidence [CoE]) and hospital mortality (OR 0.67, 95% CI 0.54–0.83, p < 0.001, I² = 39%, low CoE), despite fewer 28-day ventilator-free days and longer ECMO duration. Younger age (p = 0.005), a higher sequential organ failure assessment (SOFA) score (p = 0.022), non-Covid-19 etiology (p = 0.003), and lower rates of prone positioning before cannulation (p = 0.049) were associated with a greater benefit from prone positioning.

Conclusion

In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not. However, these findings do not imply causation. Further research is needed to clarify the role of prone positioning in this population.

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静脉-静脉体外膜氧合时俯卧位：系统回顾和荟萃分析

目的支持俯卧位在静脉-静脉体外膜氧合（V-V ECMO）治疗急性低氧性呼吸衰竭时对临床结果的益处的证据尚不明确。我们的目的是评估俯卧位与非俯卧位与不同患者亚组28天死亡率和其他临床结果的关系。方法采用随机效应模型对随机对照试验和非随机对照试验（rct）进行系统评价和meta分析。检索截止到2024年9月1日的电子数据库（PROSPERO CRD42024517602）。使用rob2和ROBINS-I工具进行偏倚风险评估。结果我们分析了2项随机对照试验和20项非随机对照试验（3465例患者）。与不使用俯卧位相比，使用俯卧位可降低28天死亡率（优势比[OR] 0.64, 95%可信区间[CI] 0.42-0.98, p = 0.040, I2 = 66%，证据确定性[CoE]低）和住院死亡率（OR 0.67, 95% CI 0.54-0.83, p < 0.001, I2 = 39%，低CoE），尽管28天无呼吸机天数较少，ECMO持续时间较长。年龄较小（p = 0.005）、序贯器官衰竭评估（SOFA）评分较高（p = 0.022）、非covid -19病因（p = 0.003）和插管前俯卧位率较低（p = 0.049）与俯卧位获益较大相关。在这项分析中，我们观察到，在支持V-V ECMO治疗急性低氧性呼吸衰竭的患者中，与没有采用俯卧位的患者相比，采用V-V ECMO的患者28天死亡率和住院死亡率有所改善。然而，这些发现并不意味着因果关系。需要进一步的研究来阐明俯卧位在这一人群中的作用。

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

Intensive Care Medicine 医学-危重病医学

CiteScore

51.50

自引率

2.80%

发文量

326

审稿时长

1 months

期刊介绍： Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.