The ongoing debate on optimal extracorporeal membrane oxygenation (ECMO) care emphasizes the need for rigorous investigation, acknowledging the value of observational data in routine The PRONECMO study, with its pragmatic approach, provides valuable insights countering the routine use of prone positioning on VV-ECMO for severe acute respiratory distress syndrome (ARDS).

Nevertheless, the implementation of this safe maneuver in specific patients, contingent upon an assessment of lesion distribution in the native lungs, should not be disregarded.

To date, the journey persists, prompting further exploration through RCTs to address critical questions concerning mechanical ventilation on ECMO, including the potential benefits of apneic ventilation or early awakening.

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