Respiratory failure & ventilation
Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis
Pooled result · 28-day mortalityResult — go to the resultOdds ratio 0.64 95% CI 0.42–0.98Authors' conclusion
In this analysis, among patients supported with V-V ECMO for acute hypoxemic respiratory failure, we observed improved 28-day and hospital mortality in those who received prone positioning, compared to those who did not.
Study context
- Population
- Patients on V–V ECMO for acute hypoxemic respiratory failure2 RCTs and 20 non-RCTs
- Participants
- 3,465 patients
- Comparison
- Prone positioning vs no prone positioning during V-V ECMO
- Outcome
- 28-day mortality
- Follow-up
- 28 days
Methodological detailsrandom-effects model, RoB 2 and ROBINS-I risk of bias assessment
- Random-effects model
- RoB 2 and ROBINS-I risk of bias assessment
Pooled result
As reported in the abstract
Odds ratio
0.64
95% CI 0.42–0.98
P = 0.040
Prone positioning vs No prone positioning
OR 0.64 (95% CI 0.42–0.98); P = 0.040
Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Hospital mortalityI2 = 39%, low CoE | 0.67 (0.54–0.83) | P < 0.001 | |
| 0.512Odds ratio (log scale) |
28-day ventilator-free days and ECMO duration
- Fewer 28-day ventilator-free days and longer ECMO duration with prone positioning
Modifiers of benefit from prone positioning (subgroup)
- Younger age associated with greater benefit
- P = 0.005
- Higher sequential organ failure assessment (SOFA) score associated with greater benefit
- P = 0.022
- Non-Covid-19 etiology associated with greater benefit
- P = 0.003
- Lower rates of prone positioning before cannulation associated with greater benefit
- P = 0.049
Original publication
Prone positioning during veno-venous extracorporeal membrane oxygenation: a systematic review and meta-analysis. Intensive Care Med. Published 29 April 2025. doi:10.
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