SynthesisCritical care (London, England)2021
Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.
Synthesis in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 4 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Effect of prone positioning in adult patients receiving veno-venous extracorporeal membrane oxygenation: A meta-analysis.PloS one · 2025Pooled it
- Guideline on positioning and early mobilisation in the critically ill by an expert panel.Intensive care medicine · 2024Guideline
- Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis.Critical care (London, England) · 2022Pooled it
- Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis.Intensive care medicine · 2022Pooled it
- Prone positioning and bleeding risk during extracorporeal membrane oxygenation in severe ARDS patients.Perfusion · 2026Observational
- Evidence-based guidelines for the use of extracorporeal membrane oxygenation in Australia and New Zealand using GRADE methodology series part 1: Venovenous extracorporeal membrane oxygenation (VV ECMO) indications and management.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Missing the target in target trial emulation: the authors reply.Critical care (London, England) · 2025Article
- Left ventricular unloading during extracorporeal cardiopulmonary resuscitation: a target trial emulation of the ELSO registry.Critical care (London, England) · 2025Article
- Impacts of initial ICU driving pressure on outcomes in acute hypoxemic respiratory failure: a MIMIC-IV database study.Scientific reports · 2024Article
- Corticosteroid treatment in COVID-19 patients receiving extracorporeal membrane oxygenation: benefit from rational use - authors' reply.Annals of intensive care · 2024Article
- Study on risk factors and treatment strategies of hypoxemia after acute type a aortic dissection surgery.Journal of cardiothoracic surgery · 2024Review
- Proning the extracorporeal membrane oxygenation plus Impella: a case report.European heart journal. Case reports · 2024Article
- Article
- Effect of prone positioning on survival in adult patients receiving venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a prospective multicenter randomized controlled study.Journal of thoracic disease · 2024Article
- Prone Positioning and Molecular Biomarkers in COVID and Non-COVID ARDS: A Narrative Review.Journal of clinical medicine · 2024Review
- Respiratory Support in COVID-19-Related Respiratory Failure: Lessons Learnt.Advances in experimental medicine and biology · 2024Review
- Reactive Oxygen Species and Strategies for Antioxidant Intervention in Acute Respiratory Distress Syndrome.Antioxidants (Basel, Switzerland) · 2023Review
- Response to Prone Position in COVID-19 and Non-COVID-19 Patients with Severe ARDS Supported by vvECMO.Journal of clinical medicine · 2023Article
- Mechanical Ventilation during ECMO: Best Practices.Respiratory care · 2023Review
- Article
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProne positioning (PP) improves oxygenation and respiratory mechanics and is associated with lower mortality in patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite this, some patients develop refractory hypoxemia and hypercapnia requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support and are usually cared for in supine position. The physiologic and outcome benefits of routine PP of patients during VV ECMO remains unclear. Hence, we conducted the systematic review and meta-analysis to evaluate the outcome benefits of PP for patients with ARDS being treated with VV ECMO.
methodsAfter registration with PROSPERO (CRD42020199723), MEDLINE, EMBASE, Scopus and Cochrane databases were searched for relevant studies that reported PP in more than 10 adult patients supported with VV ECMO from origin to 1 March 2021. Studies were reviewed for quality using appropriate Joanna Briggs Institute (JBI) checklists, and certainty of evidence was assessed using the GRADE approach. The random-effects model (DerSimonian and Laird) was used. The primary outcome of interest was cumulative survival. Secondary outcomes were intensive care unit length of stay (ICU LOS) and ECMO duration. Changes in arterial blood gas (ABG) values, ventilator mechanics and complication rates were also studied.
resultsOf 812 potentially relevant publications, 12 studies (640 patients) met our inclusion criteria. Due to overlapping study populations, 11 studies were included in the final meta-analysis. Cumulative survival in patients that underwent PP was 57% (95% CI 41.9-71.4, high certainty). Patients that underwent PP had longer ICU LOS (+ 14.5 days, 95% CI 3.4-25.7, p = 0.01) and ECMO duration (+ 9.6 days, 95% CI 5.5-13.7, p < 0.0001). After PP, patients had significantly higher PaO
conclusionsPP during VV ECMO appears safe with a cumulative survival of 57% and may result in longer ECMO runs and ICU LOS. However, evidence from appropriately designed randomized trials is needed prior to widespread adoption of PP on VV ECMO.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.