Application of prone position in hypoxemic patients supported by veno-venous ECMO

Alberto Lucchini, Christian De Felippis, Giulia Pelucchi, Giacomo Grasselli, Nicolò Patroniti, Luigi Castagna, Giuseppe Foti, Antonio Pesenti, Roberto Fumagalli

Research output: Contribution to journalArticlepeer-review


Introduction: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) is an advanced respiratory care therapy allowing replacement of pulmonary gas exchange. Despite VV-ECMO support, some patients may remain hypoxaemic. A possible therapeutic procedure for these patients is the application of prone positioning. Objective: The primary aim of the present study was to investigate modification of the PaO2/FiO2 ratio, in VV-ECMO patients with refractory hypoxaemia. The secondary aim was to evaluate the safety and feasibility of prone positioning for patients with severe Adult Respiratory Distress Syndrome supported by ECMO. Methods: We retrospectively reviewed the electronic records and charts of all patients supported by VV-ECMO who experienced at least one pronation. Complications related with prone positioning were also recorded. First PaO2/FiO2 ratio was analysed during four different time steps: before pronation, one hour after pronation, at the end of pronation and one hour after returning to supine. Results: A total of 45 prone positioning manoeuvers were performed in 14 VV-ECMO patients from November 2009 to November 2014. The median duration of prone positioning cycles was 8 h (IQR 6–10). No accidental dislodgement of intravascular lines, endotracheal tubes, chest tubes or a decrease in ECMO blood flow was observed. During the first prone positioning for each patient, the median PaO2/FiO2 ratio recorded was 123 (IQR 82–135), 152 (93–185), 149 (90–186) and 113 (74–182), during PRE-supine step, 1 h-prone positioning step, END-prone positioning step, and POST-supine step respectively. Conclusions: The application of prone positioning during VV-ECMO has shown to be a safe and reliable technique when performed in a recognised ECMO centre with the appropriately trained staff and standard procedures.

Original languageEnglish
Pages (from-to)61-68
JournalIntensive and Critical Care Nursing
Publication statusPublished - 2018


  • ARDS
  • ECLS
  • ECMO
  • Hypoxaemic patient
  • Prone position

ASJC Scopus subject areas

  • Critical Care


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