Effect of prone positioning in adult patients receiving veno-venous extracorporeal membrane oxygenation: A meta-analysis.
<h4>Objective</h4>To investigate the effects of prone positioning during extracorporeal membrane oxygenation (ECMO) and its effects on short-term and long-term survival.<h4>Methods</h4>A computerized search was performed for all studies in PubMed, Web of Science, Embase, and...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0320532 |
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| Summary: | <h4>Objective</h4>To investigate the effects of prone positioning during extracorporeal membrane oxygenation (ECMO) and its effects on short-term and long-term survival.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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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| ISSN: | 1932-6203 |