Physiologic Wins Without Survival Gain? Prone Positioning in VV-ECMO-Treated ARDS

Year 2026, Volume: 9 Issue: 1, 92 - 96, 17.03.2026

Payam Rahimi

https://izlik.org/JA88SH95CF

Abstract

Background: Prone positioning (PP) is a well-established strategy to improve oxygenation in Acute Respiratory Distress Syndrome (ARDS) patients; however, its role during Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) remains uncertain.
Objective: To evaluate the impact of PP on Intensive Care Unit (ICU) survival and respiratory parameters in patients with ARDS supported by VV-ECMO.
Methods: This retrospective observational study included 100 adult patients who underwent VV-ECMO for respiratory failure between 2015 and 2024. Patients were divided into two groups: hose who received prone positioning during ECMO (≥16 hours) and those who remained supine. Clinical characteristics, ventilatory parameters, and outcomes were compared.
Results: Forty-five patients (45%) underwent PP during ECMO. Although ICU survival was higher in the prone group (53.7% vs. 46.3%), the difference was not statistically significant (p=0.246). However, PP was associated with significant improvements in driving pressure, mechanical power, compliance, and gas exchange indices in the post-prone period.
Conclusion: While PP during VV-ECMO did not significantly improve survival, it contributed to favorable physiological changes, supporting its use as an adjunctive therapy in ARDS management under ECMO.

Keywords: Prone Positioning, ECMO, Respiratory Mechanics, ARDS, Lung Protective Ventilation

Keywords

Prone Positioning , ECMO , Respiratory Mechanics , ARDS , Lung Protective Ventilation

Sağkalıma Yansımayan Fizyolojik Kazanımlar: VV-ECMO ile Tedavi Edilen ARDS Hastalarında Prone Pozisyonunun Etkisi

https://izlik.org/JA88SH95CF

Abstract

Giriş: Prone Pozisyon (PP), Akut Respiratuar Distres Sendromu (ARDS) hastalarında oksijenasyonu iyileştirmek için yaygın olarak kullanılan bir yöntemdir; ancak Venovenöz Ekstrakorporeal Membran Oksijenizasyon (VV-ECMO) tedavisi sırasında PP, etkinliği belirsizliğini korumaktadır.
Amaç: çalışmamızda VV-ECMO desteği altındaki ARDS hastalarında PP'nin yoğun bakım mortalitesi ve solunum parametreleri üzerindeki etkisini değerlendirmek amaçlanmaktadır.
Yöntemler: Bu retrospektif gözlemsel çalışmaya, 2015-2024 yılları arasında solunum yetmezliği nedeniyle VV-ECMO uygulanan 100 erişkin hasta dahil edildi. Hastalar, ECMO sırasında en az 16 saat prone pozisyonu uygulananlar ve supin pozisyonda kalanlar olmak üzere iki gruba ayrıldı. Klinik özellikler, ventilatör parametreleri ve yoğun bakım mortalite açısından karşılaştırıldı.
Bulgular: Hastaların %45’ine (n=45) ECMO süresince PP uygulandı. Prone grubunda yoğun bakım sağkalımı daha yüksek olmakla birlikte (53.7% vs. 46.3%), istatistiksel olarak anlamlı fark bulunamadı (p=0.246). Ancak PP sonrası dönemde drive basıncı, mekanik güç, kompliyans ve oksijenizasyon parametrelerinde anlamlı iyileşmeler gözlendi.
Sonuç: VV-ECMO sırasında prone pozisyonu sağkalımı anlamlı şekilde artırmasa da, olumlu fizyolojik değişikliklere katkıda bulunarak ECMO destekli ARDS yönetiminde tamamlayıcı bir tedavi seçeneği olarak düşünülmektedir.

Anahtar Kelimeler: Prone Pozisyon, EKMO, Solunum Mekanikleri, ARDS, Akciğer Koruyucu Ventilasyon

Keywords

Prone Pozisyon , EKMO , Solunum Mekanikleri , ARDS , Akciğer Koruyucu Ventilasyon

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