Veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome: should the EOLIA Study results change our clinical approach?

Grasselli, Giacomo; Zanella, Alberto; Pesenti, Antonio

doi:10.23736/s0375-9393.19.13490-6

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…30 Our study did not record any ECMO cannularelated complications or loss of vascular catheters (central venous lines or arterial lines): these observations are also shared by previous safety reports involving paediatric and adult patients on ECMO. 7,[31][32][33][34][35] The expertise of nursing staff is fundamental in the prevention of complications due to prone positioning during ECMO. We may speculate that no cannula-related complications were recorded because the manoeuvre is safely performed at our hub center by an experienced team (one intensivist, four ICU nurses, one perfusionist).…”

Section: Discussionmentioning

confidence: 99%

Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross‐sectional study

Binda

Marelli

Galazzi

et al. 2023

Nursing in Critical Care

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BackgroundThe combination of prone positioning and extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) is recognized as safe but its use has been limited due to potential complications.ObjectiveTo report the prevalence of pressure ulcers and other complications due to prone positioning in adult patients receiving veno–venous ECMO.MethodsThis cross‐sectional study was conducted in a tertiary level intensive care unit (ICU) in Milan (Italy), between January 2015 and December 2019. The study population was critically ill adult patients undergoing veno–venous ECMO. Statistical association between pressure ulcers and the type of body positioning (prone versus supine) was explored fitting a logistic model.ResultsIn the study period, 114 patients were treated with veno–venous ECMO and 62 (54.4%) patients were placed prone for a total of 130 prone position cycles. ECMO cannulation was performed via femoro–femoral configuration in the majority of patients (82.4%, 94/114). Pressure ulcers developed in 57.0% of patients (95%CI: 44.0%–72.6%), most often arising on the face and the chin (37.1%, 23/62), particularly in those placed prone. The main reason of prone positioning interruption was the decrease of ECMO blood flow (8.1%, 5/62). The fitted model showed no association between body position during ECMO and occurrence of pressure ulcers (OR 1.3, 95%CI: 0.5–3.6, p = .532).ConclusionFacial pressure ulcers were the most frequent complications of prone positioning. Nurses should plan and implement evidence‐based care to prevent such pressure injuries in patients undergoing ECMO.Relevance to Clinical PracticeThe combination of prone positioning and ECMO shows few life‐threating complications. This manoeuvre during ECMO is feasible and safe when performed by experienced ICU staff.

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Section: Discussionmentioning

confidence: 99%

Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross‐sectional study

Binda

Marelli

Galazzi

et al. 2023

Nursing in Critical Care

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“…Several case series have already shown the feasibility and the safety of combining prone position and ECMO support in ARDS patients (24, 25). However, whether the combination is beneficial for ARDS patients remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Our data also highlight a rapid increase in the use of prone positioning for patients on ECMO in French ICUs that appears to have accompanied the COVID-19 pandemic. Several case series have already shown the feasibility and the safety of combining prone position and ECMO support in ARDS patients (24,25). However, whether the combination is beneficial for ARDS patients remains unclear.…”

Section: Feature Articlesmentioning

confidence: 99%

Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation*

Massart

Guervilly

Mansour

et al. 2022

Critical Care Medicine

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Prone positioning and venovenous extracorporeal membrane oxygenation (ECMO) are both useful interventions in acute respiratory distress syndrome (ARDS). Combining the two therapies is feasible and safe, but the effectiveness is not known. Our objective was to evaluate the potential survival benefit of prone positioning in venovenous ECMO patients cannulated for COVID-19-related ARDS.DESIGN: Retrospective analysis of a multicenter cohort. PATIENTS:Patients on venovenous ECMO who tested positive for severe acute respiratory syndrome coronavirus 2 by reverse transcriptase polymerase chain reaction or with a diagnosis on chest CT were eligible. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:All patients on venovenous ECMO for respiratory failure in whom prone position status while on ECMO and in-hospital mortality were known were included. Of 647 patients in 41 centers, 517 were included. Median age was 55 (47-61), 78% were male and 95% were proned before cannulation. After cannulation, 364 patients (70%) were proned and 153 (30%) remained in the supine position for the whole ECMO run. There were 194 (53%) and 92 (60%) deaths in the prone and the supine groups, respectively. Prone position on ECMO was independently associated with lower in-hospital mortality (odds ratio = 0.49 [0.29-0.84]; p = 0.010). In 153 propensity score-matched pairs, mortality rate was 49.7% in the prone position group versus 60.1% in the supine position group (p = 0.085). Considering only patients alive at decannulation, propensity-matched proned patients had a significantly lower mortality rate (22.4% vs 37.8%; p = 0.029) than nonproned patients.CONCLUSIONS: Prone position may be beneficial in patients supported by venovenous ECMO for COVID-19-related ARDS but more data are needed to draw definitive conclusions.

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“…Part of this rationale is based on the fact that reduction in ventilator pressures during VV-ECMO can lead to derecruitment of the lung, which could favor ventilator-induced lung injury (atelectrauma), hypoxemia (despite ECMO), or liberation failure. 7 Prone positioning during VV-ECMO might reduce decruitment or mitigate its consequences. 8 Simultaneous use of both strategies has been reported in numerous observational studies, which have been summarized in recent meta-analyses.…”

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confidence: 99%

“…In contrast, at least 5 of the 11 observational studies claiming survival benefit from prone positioning during ECMO had specific indications for the intervention, such as refractory hypoxemia despite optimization of ventilation and ECMO or failure to wean from ECMO with or without evidence of consolidation on chest imaging. 7,[12][13][14][15][16][17][18][19] Indeed, if patients are adequately supported with VV-ECMO and have their mechanical ventilatory support reduced to very low levels that are unlikely to propagate ventilator-induced lung injury, it is unclear how early prone positioning would further reduce ventilator-induced lung injury and mortality. It remains unknown whether different results would be achieved if tested in patients in whom prone positioning has stronger potential biological indications.…”

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confidence: 99%

Prone Positioning During Venovenous ECMO for Severe ARDS

Teijeiro-Paradis,

Ferguson

2023

JAMA

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Veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome: should the EOLIA Study results change our clinical approach?

Abstract: The final version may contain major or minor changes.Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissions send an email to:

Cited by 12 publications

References 22 publications

Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross‐sectional study

Pressure ulcers after prone positioning in patients undergoing extracorporeal membrane oxygenation: A cross‐sectional study

Impact of Prone Position in COVID-19 Patients on Extracorporeal Membrane Oxygenation*

Prone Positioning During Venovenous ECMO for Severe ARDS

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