Extracorporeal membrane oxygenation in adult patients with acute respiratory distress syndrome.

Purpose of review
To examine the role of extracorporeal membrane oxygenation (ECMO) as potential therapeutic option for
severe cases of acute respiratory distress syndrome (ARDS).
Recent findings
The use of ECMO to treat acute respiratory failure dramatically increased. Factors that may explain this
increase in the use of ECMO are H1N1 pandemic influenza, results of recent clinical trials and not lastly
the technological development and consequently the commercial pressure of the industry. Under these
circumstances, clinicians urgently need clinical trials and formal indication, contraindication and rules for
implementation to provide reproducible results.
Summary
Guidelines from the Extracorporeal Life Support Organization still indicate ECMO for acute severe
pulmonary failure potentially reversible and unresponsive to conventional management. The new definition
of ARDS (Berlin definition) addresses clinicians to the best treatment options in respect of the severity of
illness and allocates ECMO as a potential therapeutic option for patients with severe ARDS and a P/F ratio
lower than 100 and proposed that the indication of ECMO may be shifted from the treatment of choice for
refractory hypoxemia to the treatment of choice to minimize ventilator-induced lung injury.