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Table 1 Comparison of different studies on VV ECMO combined with prone positioning in patients with severe ARDS

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

  1. NA not applicable, SOFA sequential organ failure assessment, SAPS II simplified acute physiology score, IQR interquartile range, CI confidence interval, PP prone positioning, SP supine positioning, VV venovenous, ECMO extracorporeal membrane oxygenation, MV mechanical ventilation, NMBA neuromuscular blocking agents
  2. *Studies focused on patients with SARS-CoV-2-induced ARDS