We read with great interest the network meta-analysis by Sud et al. comparing venovenous extracorporeal membrane oxygenation (VV-ECMO), prone positioning, and supine mechanical ventilation in patients with severe hypoxemic acute respiratory distress syndrome (ARDS).

The study provides valuable insights, and we com-mend the authors for their comprehensive work. However, we would like to address several methodological concerns and potential inconsistencies.

While Sud et al.’s network meta-analysis provides important findings on the relative efficacy of VV-ECMO and prone ventilation for severe ARDS, the methodological limitations and variability in study designs caution against overinterpretation of the results. We advocate for more high-quality, direct comparative studies to better inform clinical practice.

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