ABSTRACT
Evidence from cohort studies, meta-analyses, and randomized controlled trials has shown that venovenous extracorporeal membrane oxygenation (VV-ECMO) support for patients with acute respiratory distress syndrome (ARDS) who develop refractory hypoxemia may be associated with improved outcomes. VV ECMO is an extracorporeal therapy that consists of cannulae that drain venous blood through a pump into an oxygenator allowing for gas exchange with subsequent return of oxygenated blood into a central vein. The ECMO to Rescue Lung Injury in Severe ARDS trial published in 2018 was a prospective, multicenter, randomized controlled trial that evaluated the effect of early initiation of VV-ECMO in severe ARDS. The chapter aims to establish the safety of routine VV ECMO use in patients with severe ARDS and provided guidance regarding ECMO cannulation criteria. VV ECMO has now been established as a safe rescue modality in patients with severe hypoxemia refractory to the, especially at centers that frequently use ECMO.
