From: Prone positioning in ARDS patients supported with VV ECMO, what we should explore?
References | Pre ECMO | During ECMO | Mortality (%) PP vs. SP | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Score | Receiving PP, n (%) | MV-to-ECMO Day, d | Reasons to perform PP | ECMO-to-PP Day, d | Receiving PP, n (%) | PP duration per session, h | PP sessions | Sedation and NMBA | ||
*Zaaqoq [77] Multicenter, retrospective 2022 | SOFA 7 (IQR 4–9) | 49 (73) | 4 (IQR 2–8) | Depended on clinician discretion | NA | 67 (29) | NA | 6 (IQR 2–14) | NA | Hospital: 67 vs. 78 (hazard ratio, 0.31; 95% CI 0.14–0.68) |
Petit [20] Single center retrospective 2022 | SOFA 13 (IQR 9–16) | 55 (86) | 4 (IQR 1–9) | Severe hypoxemia, extensive lung consolidation, or difficult ECMO-weaning | 3 (IQR 2–6) | 64 (21) | 16 | 2 (1–2) per patients | Deeply sedated with NMBA | 90-day, unadjusted: 20 vs. 48 (P < 0.01), adjusted: 20 vs. 42 (P < 0.01) |
*Laghlam [42] Single center prospective 2021 | SOFA 11 (IQR 6–14) | 10 (100) | 5 (IQR 4–10) | Based on PaO2/FiO2 ratio value and left at the discretion of the attending physician | 2 (IQR 1–3) | 10 (41) | 17.4 ± 2.1 | 3 (IQR 2–5) | Deeply sedated with NMBA | 60-day, unadjusted: 40 vs. 43 (P = 0.99) |
Giani [12] Multicenter, retrospective 2021 | SOFA 9 ± 3 | 34 (31) | 2 (IQR 1–6) | Based on the clinical judgement of attending physicians | 4 (IQR 2–7) | 107 (45) | 15 (IQR 12–18) | Total 326 | NA | Hospital, unadjusted: 34 vs. 49 (P = 0.017), adjusted: 30 vs. 53 (P = 0.024) |
Rilinger [44] Single center, retrospective 2020 | SOFA 11 (IQR 11–15) | 7 (18) | 2.2 (IQR 0.2–7.6) | Judged by the treating medical team | 1.7 (IQR 0.5–5.0) | 38 (24) | 19.5 (IQR 16.8–20.8) | 2 (1–3) per patients | Titrated to preserve spontaneous breathing if possible | Hospital, unadjusted: 63.2 vs. 63.3 (P = 0.984), adjusted: 63.2 vs. 63.2 (P = 1.0) |
*Garcia [10] Single center retrospective 2020 | SAPS II 59.5 (IQR 46–62) | 14 (100) | 6.5 (IQR 4–10) | Severe hypoxemia or extensive lung consolidation on chest imaging (> 50% of lung volume) | 1.5 | 14 (56) | 16 (IQR 15–17) | Total 24 | NA | 28-day, unadjusted: 78.6 vs. 27.3 (P = 0.02) |
Franchineau [19] Single center prospective 2020 | SOFA 13 (IQR 11–16) | 16 (76) | 8 (IQR 6–11) | ARDS patients on VV ECMO without contraindications | 2 (IQR 1–5) | 21 (100) | 16 | 2 (1–2) per patients | Deeply sedated and paralyzed | NA |
Guervilly [41] Single center retrospective 2019 | SOFA 10 ± 4 | 69 (76) | 5 ± 5 | Persistent hypoxemia, failure of attempt to wean ECMO after at least 10 days of ECMO and the presence of lung consolidations on chest X-ray or lung ultrasounds, or according to the physician in charge of the patient | 5 ± 4 | 91 (54) | 12–16 | 3 (1–17) | Deeply sedated and paralyzed | 90-day, unadjusted: 38 vs. 58 (P = 0.008), adjusted: 42 vs. 64 (P = 0.028) |
Kimmoun [11] Single Center, retrospective 2015 | SOFA 12 (IQR 8–15) | 13 (76) | NA | Refractory hypoxemia combined or not with persistent high plateau pressure or unsuccessful ECMO weaning attempt after day 7 | 6 (IQR 4–12) | 17 (38) | 24 | Total 27 | NA | NA |
Guervilly [13] Single center prospective 2014 | SOFA 9 (IQR 8–11) | 9 (60) | 6.5 (IQR 1–9) | Severe hypoxemia, injurious ventilation parameters or failure of attempt to wean ECMO after at least 10 days of ECMO | 8 (IQR 5–10) | 15 (32) | 12 | Total 21 | Deeply sedated and paralyzed | NA |