Prone positioning in ARDS patients treated with veno-venous extracorporeal membrane oxygenation: feasibility and benefits

Abstract

Venovenous extracorporeal membrane oxygenation (ECMO-VV) has become a standard of care in the most severe cases of acute respiratory distress syndrome despite the use of prone positioning. Whether prone positioning should be continued under ECMO-VV is an important question considering on one hand its expected benefit but also on the other hand the technical difficulty of its realization in these patients. Most of observational studies showed a further increase in oxygenation when patients under ECMO-VV are turned prone. In addition, several meta-analysis of non-randomized comparative studies suggest a lower mortality in patients turned prone early while under ECMO-VV. Nevertheless, randomized controlled trials are necessary in order to precise its indications and modalities. In this review, we discuss the physiopathological rationale for turning prone patients under ECMO-VV, its possible indications and feasibility. Finally, we discuss its practical aspects.