Prone position ventilation for pediatric acute respiratory distress syndrome with ECMO: a retrospective observational study in China

Background Extracorporeal membrane oxygenation (ECMO) and prone position ventilation (PPV) have been used for rescuing severe pediatric acute respiratory distress syndrome (PARDS) for half a century. We aimed to compare the outcomes and effectiveness of PARDS patients with ECMO + PPV and ECMO through a retrospective multicenter observational study. Methods In the present study, 170 PARDS patients with criteria of ECMO from 9 hospitals in 7 years were collected. 1:2 propensity score matching was conducted and the outcomes of severe PARDS patients were analyzed. The effectiveness of PPV was compared as well. The primary outcome was 28-day mortality and survival ECMO rate. Secondary outcomes included ECMO running time, ventilator free time, PICU time and hospital days of survivors. Results Among 170 patients, 117 patients received ECMO + PPV and 53 patients didn't. After matching, we got fifty pairs. For the survivors, the ECMO running time was significantly lower [6.9[4.7,10.7] vs.9.6[6.7,15.0]] and ventilator free time was significantly longer [18.0[10.33,21.63] vs.7.02[5.0,15.4]] in the ECMO + PPV group than those in the ECMO group ( P < 0.05). Among the survivors who received ECMO + PPV, the PaO 2 , Oxygen Index (OI) and PaO 2 /FiO 2 increased significantly during the PPV period ( P < 0.01) and sustained for 4 h at least. However, the 28-day mortality in both groups showed no significant difference (48.0% vs. 50.0%, P = 0.863). Conclusions By far, there has been no ECMO + PPV effectiveness study in severe PARDS patients. This study found that PPV was associated with less ECMO running time and ventilator free time. However, PPV was not associated with survival rate with PARDS patients on ECMO. Clinical trial registration This study was registered at Chinese clinical trial registry (chiCTR.gov; Identifier: ChiCTR1800019555). Registered date is 18 November 2018. Name of the registry: Extracorporeal membrane oxygenation in critical ill children with severe acute respiratory distress syndrome—A multicenter study.