Prone positioning before extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: A retrospective multicenter study

Abstract Objective To evaluate the clinical outcomes of patients with severe acute respiratory distress syndrome (ARDS) subjected to prone positioning before extracorporeal membrane oxygenation (ECMO). Design A retrospective analysis of a multicenter cohort was carried out. Setting Patients admitted to the Intensive Care Units of 11 hospitals in Korea. Patients Patients were divided into those who underwent prone positioning before ECMO ( n  = 28) and those who did not ( n  = 34). Interventions None. Variables of interest Thirty-day mortality, ECMO weaning failure rate, mechanical ventilation weaning success rate, mechanical ventilation-free days at day 60. Results The prone group had lower median peak inspiratory pressure and lower median dynamic driving pressure before ECMO. Thirty-day mortality was 21% in the prone group and 41% in the non-prone group ( p  = 0.098). The prone group also showed a lower ECMO weaning failure rate, and a higher mechanical ventilation weaning success rate and more mechanical ventilation-free days at day 60. In the non-prone group, median dynamic compliance marginally decreased shortly after ECMO, but no significant change was observed in the prone group. Conclusions Prone positioning before ECMO was not associated to increased mortality and tended to exert a protective effect.