Prone Positioning Does Not Impact ECMO Weaning Time in Covid patients with Severe ARDS: JAMA

A randomized clinical trial by Matthieu Schmidt and team investigated the impact of prone positioning on patients with severe acute respiratory distress syndrome (ARDS) undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO). The findings of the study were published in the Journal of American Medical Association.

The trial was conducted from March 3, 2021, to December 7, 2021, aimed to discern whether prone positioning would decrease the time to successful ECMO weaning. The study involved 170 patients with severe ARDS across 14 intensive care units in France, with a median age of 51 years, of which 35% were women. Notably, 94% of patients had ARDS related to COVID-19. Patients were randomized into a group undergoing prone positioning (at least 4 sessions of 16 hours), and the other in a supine position.

Within 60 days of enrollment, the results of the study indicated that there was no significant difference in the time to successful ECMO weaning between the two groups. In the prone ECMO group, 44% of patients experienced successful ECMO weaning when compared to 44% in the supine ECMO group. Moreover, within 90 days, no significant disparities were observed in ECMO duration, length of stay in ICU, or 90-day mortality rates.

Although prone positioning showed promise in improving outcomes for patients with severe ARDS, the findings suggest that its application did not significantly reduce the time to successful ECMO weaning in this particular patient population. 

The findings underscore the complexity of managing severe respiratory conditions and the importance of evidence-based approaches in critical care. As discussions on respiratory care continue to evolve, research endeavors like this shed light on the nuances of treatment strategies, helping refine protocols for better patient outcomes in intensive care settings.

Source:

Schmidt, M., Hajage, D., Lebreton, G., Dres, M., Guervilly, C., Richard, J. C., Sonneville, R., Winiszewski, H., Muller, G., Beduneau, G., Mercier, E., Roze, H., Lesouhaitier, M., Terzi, N., Thille, A. W., Laurent, I., Kimmoun, A., Combes, A., … Luyt, C. E. (2023). Prone Positioning During Extracorporeal Membrane Oxygenation in Patients With Severe ARDS. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2023.24491