CASE PRESENTATION: A 41 years old morbid obese female (BMI = 56) developed ARDS due to influenza pneumonia. The patient remained hypoxic despite maximal medical and ventilator management and required veno-venous ECMO (VV ECMO). Computerized tomography scan of the chest showed posterior consolidation; however, prone bed was initially not used due to body habitus and weight of 138 Kg. On POD#12, CXR showed no improvement despite ECMO, antiviral therapy and ARDS ventilation support. High frequency oscillatory ventilation was initiated; respiratory status remained unchanged after 5 days. On ECMO day #17, she was placed on a Rotaprone ™ bed (KCI, San Antonio, TX), knowing the risk of the compression of the thorax due to the body habitus (large breasts) and excessive BMI. Consolidation on CXR significantly improved (Figure 1). Oxygen saturation was significantly better in prone position (average 84% in supine position vs. 99% in prone position, Figure 2A). Respiratory compliance improved from 12 to 24ml/cm H2O and mean airway pressure was improved from 26 to 13 cm H2O (Figure 2B). The patient was successfully weaned off ECMO support after 25 days (7 days on prone bed).