To systematically evaluate the effect of prone position ventilation on mortality in patients with acute respiratory distress syndrome (ARDS) supported by veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Randomized controlled studies or observational studies concerning prone position ventilation for ARDS patients supported by VV-ECMO published from January 2002 to January 2022 in Medline, Embase, Cochrane Library, Wangfang and CNKI databases were searched comprehensively and systematically. Two reviewers independently screened articles, extracted data and evaluated methodological quality. Then meta-analysis was performed using the RevMan 5.3.

A total of 14 articles with 1 880 patients were enrolled in this study, 869 patients in the experimental group (prone position ventilation) and 1 011 patients in the control group (supine position ventilation). Meta-analysis showed that the 28-day mortality [relative risk (RR) = 0.59, 95% confidence interval (CI) (0.43, 0.80), Z = 3.41, P = 0.000 7] and in-hospital mortality [RR = 0.73, 95%CI (0.66, 0.81), Z = 5.86,P < 0.000 01] in the experimental group were much lower than those in the control group. However, the other mortality (30-day, 60-day, 90-day, ICU and 6-month mortality) was not significantly different between the two groups [RR = 0.80, 95%CI (0.61, 1.05), Z = 1.60, P = 0.11].

Prone position ventilation can reduce the 28-day mortality and in-hospital mortality in ARDS patients supported by VV-ECMO.