This systematic review and meta-analysis of 13 studies (total N = 1836) showed that PP of acute respiratory distress syndrome (ARDS) patients receiving venovenous ECMO (vvECMO) was associated with a significant improvement in 28-day survival compared with supine positioning of ECMO patients.

All other timepoints, including hospital survival, showed a beneficial effect of PP on patients receiving ECMO.

According to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO.

The impact of this combination on survival should be investigated in prospective randomized controlled trials.

Thirteen studies with a combined population of 1836 patients satisfied the inclusion criteria.

PP was associated with a significant improvement in 28-day survival.

Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival).

In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP.

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