Background: Prone positioning is a well-established strategy to improve oxygenation in patients with severe ARDS. However, its use in patients receiving ECMO remains controversial due to concerns regarding circuit stability, cannula displacement, and staff safety. This case series explores the feasibility, timing, safety, and outcomes of prone positioning in patients supported on VV ECMO, including those who did not tolerate proning. Methods: We retrospectively reviewed 15 patients with severe ARDS managed with venovenous ECMO who underwent prone positioning between 2022 and 2025 at Apollo Multispeciality Hospitals, Kolkata. Demographics, indications for ECMO, duration of proning, hemodynamic and oxygenation parameters before and after proning, and procedure-related complications were analyzed. Results: Prone positioning on ECMO was feasible in the majority of patients, with notable improvement in oxygenation parameters post-proning. No major cannula-related complications were observed when proning was performed with a structured, multidisciplinary approach. Some patients did not tolerate proning due to hemodynamic instability, highlighting the need for careful patient selection. Conclusion: Prone positioning in patients on VV ECMO is feasible and can significantly enhance oxygenation when executed with coordinated multidisciplinary care. Ensuring collaboration between perfusion, nursing, and medical teams is essential for safety and optimizing patient outcomes. Larger studies are warranted to further define the role, timing, and patient selection for proning during ECMO support.
Jamadar et al. (Sun,) studied this question.