Clinical review reveals conflicting physiological and survival outcomes during extracorporeal membrane oxygenation in severe ARDS, highlighting the need to clarify potential mortality risks.
Prone positioning (PP) decreases mortality in patients with severe ARDS.1 In patients with ARDS treated with venovenous extracorporeal membrane oxygenation (VV-ECMO), PP may have physiologic benefits on respiratory mechanics and redistribution of tidal ventilation2 and may improve hospital survival.3,4 The clinical use of PP in these patients is growing.5 However, a recent small randomized control trial that assessed the effect of ultraprotective ventilation (1-2 mL/kg predicted body weight) and PP in patients with ARDS receiving VV-ECMO6 did not find a reduction of biotrauma, but did show a trend toward increased mortality.
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García-de-Acilu et al. (2023) studied this question.
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