[Prone positioning during venovenous extracorporeal membrane oxygenation: challenges and value].

The routine use of prone positioning during venovenous extracorporeal membrane oxygenation (VV-ECMO) remains controversial. While observational studies suggest a potential survival benefit in patients with acute respiratory distress syndrome (ARDS) supported by VV-ECMO, the recent negative findings from the PRONECMO trial have prompted renewed scrutiny of its clinical value. This article summarizes current evidence, examines the challenges and potential benefits of prone positioning during VV-ECMO, interpretates the negative results from the PRONECMO trial, and emphasizes the need for future studies to refine implementation strategies and evaluate its efficacy in different patient subgroups, with the goal of guiding more precise clinical decision-making.