Prone Positioning on VV ECMO

Prolonged prone positioning on VV ECMO has recently been reported as beneficial by Levy et al in Annals of Intensive Care.  We presented another blog post in November 2015 related to Prone Positioning on ECMO.

Levy’s report does not show improved outcome directly, but unlike some other reports, he shows that by keeping the VV ECMO patient prone for 24 hours (rather than up to 12 hours as practiced by others) there is an improved ability to effect lung compliance allowing for safely increasing positive pressure ventilation that ultimately allows the patient to wean off of VV ECMO.

In the past, several studies indicated improved oxygenation during prone positioning on ECMO, but there was less indication that patients actually had better outcomes.  In addition, there has been a lot of concern regarding the risks involved in using prone positioning on ECMO.  There seems to be a growing body of evidence that would indicate there is benefit in prone positioning on ECMO that would lead to justified use.

Levy’s report also presents a very nice protocol for how they determine who needs prone positioning on VV ECMO, how to manage the VV ECMO, how to manage the ventilator, and how to wean the patient off of ECMO.

This article also states absence of serious adverse events providing some level of comfort in the safety factor involved in use of prone positioning on VV ECMO.