{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T02:24:14Z","timestamp":1788056654604,"version":"build-2784847793"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T00:00:00Z","timestamp":1771632000000},"content-version":"vor","delay-in-days":1361,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,6,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory failure, including acute respiratory distress syndrome, has become better defined in recent years in light of emerging high-quality evidence and technological advances. Use of ECMO has consequently increased throughout many parts of the world. The coronavirus disease (COVID-19) pandemic, however, has highlighted deficiencies in organizational capacity, research capability, knowledge sharing, and resource use. Although governments, medical societies, hospital systems, and clinicians were collectively unprepared for the scope of this pandemic, the use of ECMO, a highly resource-intensive and specialized form of life support, presented specific logistical and ethical challenges. As the pandemic has evolved, there has been greater collaboration in the use of ECMO across centers and regions, together with more robust data reporting through international registries and observational studies. Nevertheless, centralization of ECMO capacity is lacking in many regions of the world, and equitable use of ECMO resources remains uneven. There are no widely available mechanisms to conduct large-scale, rigorous clinical trials in real time. In this critical care review, we outline lessons learned during COVID-19 and prior respiratory pandemics in which ECMO was used, and we describe how we might apply these lessons going forward, both during the ongoing COVID-19 pandemic and in the future.<\/jats:p>","DOI":"10.1164\/rccm.202111-2661cp","type":"journal-article","created":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T15:45:52Z","timestamp":1645803952000},"page":"1382-1390","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":42,"title":["Extracorporeal Membrane Oxygenation during Respiratory Pandemics: Past, Present, and Future"],"prefix":"10.1093","volume":"205","author":[{"given":"Daniel","family":"Brodie","sequence":"first","affiliation":[{"name":"Columbia University College of Physicians and Surgeons\/New York-Presbyterian Hospital, New York, New York"},{"name":"Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-3897","authenticated-orcid":false,"given":"Darryl","family":"Abrams","sequence":"additional","affiliation":[{"name":"Columbia University College of Physicians and Surgeons\/New York-Presbyterian Hospital, New York, New York"},{"name":"Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme","family":"MacLaren","sequence":"additional","affiliation":[{"name":"Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health System, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal E.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Barbaro","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn S.","family":"Calfee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine L.","family":"Hough","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-anne","family":"Fowles","sequence":"additional","affiliation":[{"name":"Intensive Care, Division of Surgery, Transplant and Anaesthetics, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Karagiannidis","sequence":"additional","affiliation":[{"name":"ARDS and ECMO Center Cologne-Merheim, Witten\/Herdecke University, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur S.","family":"Slutsky","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Critical Care Medicine, Department of Medicine, Unity Health Toronto, and"},{"name":"Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Combes","sequence":"additional","affiliation":[{"name":"Sorbonne University, INSERM, UMRS1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; and"},{"name":"Service de M\u00e9decine Intensive-R\u00e9animation, Institut de Cardiologie, Assistance Publique \u2013 H\u00f4pitaux de Paris Sorbonne H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"2026022020574647200_bib1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1164\/rccm.201205-0815OC","article-title":"Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis","volume":"187","author":"Pham","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026022020574647200_bib2","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1001\/jama.2011.1471","article-title":"Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1)","volume":"306","author":"Noah","year":"2011","journal-title":"JAMA"},{"key":"2026022020574647200_bib3","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1016\/S0140-6736(09)61069-2","article-title":"Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial","volume":"374","author":"Peek","year":"2009","journal-title":"Lancet"},{"key":"2026022020574647200_bib4","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1001\/jama.2019.9302","article-title":"Extracorporeal life support for adults with respiratory failure and related indications: a review","volume":"322","author":"Brodie","year":"2019","journal-title":"JAMA"},{"key":"2026022020574647200_bib5","doi-asserted-by":"crossref","first-page":"118","DOI":"10.3947\/ic.2016.48.2.118","article-title":"Clinical presentation and outcomes of Middle East respiratory syndrome in the Republic of Korea","volume":"48","author":"Choi","year":"2016","journal-title":"Infect Chemother"},{"key":"2026022020574647200_bib6","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1097\/CCM.0000000000002621","article-title":"Critically ill patients with the Middle East respiratory syndrome: a multicenter retrospective cohort study","volume":"45","author":"Arabi","year":"2017","journal-title":"Crit Care Med"},{"key":"2026022020574647200_bib7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13613-017-0350-x","article-title":"Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus","volume":"8","author":"Alshahrani","year":"2018","journal-title":"Ann Intensive Care"},{"key":"2026022020574647200_bib8","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome","volume":"378","author":"Combes","year":"2018","journal-title":"N Engl J Med"},{"key":"2026022020574647200_bib9","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1001\/jama.2018.14276","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc Bayesian analysis of a randomized clinical trial","volume":"320","author":"Goligher","year":"2018","journal-title":"JAMA"},{"key":"2026022020574647200_bib10","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S2213-2600(18)30452-1","article-title":"Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis","volume":"7","author":"Munshi","year":"2019","journal-title":"Lancet Respir Med"},{"key":"2026022020574647200_bib11","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1007\/s00134-020-06248-3","article-title":"ECMO for severe ARDS: systematic review and individual patient data meta-analysis","volume":"46","author":"Combes","year":"2020","journal-title":"Intensive Care Med"},{"key":"2026022020574647200_bib12","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1164\/rccm.202008-3039OC","article-title":"Comparative effectiveness of protective ventilation strategies for moderate and severe acute respiratory distress syndrome. 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