Effect of prone positioning in adult patients receiving veno-venous extracorporeal membrane oxygenation: A meta-analysis

TL;DR

This study examines whether placing adult patients on their stomachs during ECMO treatment improves survival and recovery outcomes.

Contribution

The study provides a meta-analysis of prone positioning effects during ECMO, revealing short-term survival benefits but no significant long-term advantages.

Findings

Prone positioning during ECMO significantly improved 28-day survival and survival at discharge in non-COVID-19 patients.

Short-term survival benefits were observed in matching analysis but not in long-term survival rates.

Prone positioning reduced ECMO and ICU stay durations compared to non-prone positioning.

Abstract

To investigate the effects of prone positioning during extracorporeal membrane oxygenation (ECMO) and its effects on short-term and long-term survival.

A computerized search was performed for all studies in PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2023, including prospective and retrospective clinical studies of ECMO-treated patients with or without prone positioning. Titles, abstracts, and full-text articles were screened in duplicate by two investigators. The primary outcome was short‐term survival (survival at discharge or 1-month survival). The secondary outcomes included long-term survival (60-day survival, 90-day survival), ECMO duration, length of intensive care unit (ICU) stay and ECMO weaning.

Fifteen studies with 2608 patients were included, most of which were retrospective. The effect of prone versus non-prone positioning in ECMO patients was OR =  1.32; 95% CI, 0.88–1.97; P =  0.18 for short-term survival from the original data. The effects of prone positioning during ECMO were a significant increase in 28-day survival (OR = 2.54; 95% CI 1.71–3.76; P < 0.00001) and survival at discharge (OR = 1.49; 95% CI 1.11–2.00; P = 0.009), which appeared in the non-COVID-19 patient group. Furthermore, the short-term effects of prone ventilation in ECMO patients were also improved in the matching analysis (OR = 1.66; 95% CI, 1.23–2.23; P = 0.0008), but did not in the long-term survival rate (OR = 1.57; 95% CI, 0.90–2.76; P = 0.11). The durations of ECMO (OR = 1.99; 95% CI, 1.99–2.70; P < 0.00001) and ICU stay (OR = 1.17; 95% CI, 0.58–1.75; P < 0.0001) were significantly different between the prone group and the non-prone group.

Prone position ventilation during ECMO confers no significant advantage in improving long-term survival and only slightly benefits short-term survival. Therefore, the prone position during ECMO should be carefully considered because further randomized clinical trials on this subject are needed.

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