ECMO for refractory hypoxia; current state of the art and future directions

Refractory hypoxia in adult respiratory distress syndrome remains a highly lethal process. Low tidal volume ventilation maneuvers have improved outcomes. In severe Acute Respiratory Distress Syndrome (ARDS), the mortality remains high. Veno-Venous ExtracorporealMembranous Oxygenation (VV ECMO) has been employed to treat this very sickgroup of patients. The proper selection of patients for VV ECMO as well as proper critical care management while on ECMO remains the key to improved outcomes. This review article details the current state of the art therapy for VV ECMO for refractory hypoxia, and describes controversies and future directions.