Review

. 2025 Sep;51(9):1674-1686.

doi: 10.1007/s00134-025-08070-1. Epub 2025 Aug 6.

Extracorporeal life support for adult patients with ARDS

Alain Combes^#^{1

2}, Alexander Supady^#³, Darryl Abrams⁴, Cara Agerstrand⁴, Jenelle Badulak⁵, Luigi Camporota^{6

7}, Eddy Fan^{8

9

10}, Niall D Ferguson^{8

9

10}, John F Fraser^{11

12

13

14

15

16}, Carol Hodgson^{17

18

19

20}, Samir Jaber²¹, Graeme MacLaren²², Brijesh V Patel^{23

24}, Giles J Peek²⁵, Matthieu Schmidt^{1

2}, Kiran Shekar^{12

26}, Arthur S Slutsky^{8

27}, Daniel Brodie^#²⁸

Affiliations

¹ Institute of Cardiometabolism and Nutrition, Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Paris, France.
² Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France.
³ Interdisciplinary Medical Intensive Care, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany.
⁴ Division of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian / Columbia University Irving Medical Center, New York, NY, USA.
⁵ Department of Emergency Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA.
⁶ Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁷ Centre for Human and Applied Physiological Sciences, School of Basic & Medical Biosciences, King's College London, London, UK.
⁸ Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Management, and Evaluation, Institute of Health Policy, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada.
¹¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
¹² University of Queensland, Brisbane, Australia.
¹³ Queensland University of Technology, Brisbane, Australia.
¹⁴ Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia.
¹⁵ Wesley Medical Research, Brisbane, Australia.
¹⁶ School of Medicine, Griffith University, Brisbane, Australia.
¹⁷ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁸ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁹ Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia.
²⁰ University of Melbourne, Parkville, VIC, Australia.
²¹ Department of Anaesthesiology and Critical Care Medicine B (DAR B), PhyMed Exp, INSERM U1046 Montpellier, Saint-Eloi Hospital, University Teaching Hospital of Montpellier, University of Montpellier, Montpellier, France.
²² Cardiothoracic ICU, National University Hospital, Singapore, Singapore.
²³ Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK.
²⁴ Department of Critical Care Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁵ Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA.
²⁶ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
²⁷ Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
²⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA. DanielBrodie@jhu.edu.

^# Contributed equally.

PMID: 40768066
DOI: 10.1007/s00134-025-08070-1

Free article

Review

Extracorporeal life support for adult patients with ARDS

Alain Combes et al. Intensive Care Med. 2025 Sep.

Free article

. 2025 Sep;51(9):1674-1686.

doi: 10.1007/s00134-025-08070-1. Epub 2025 Aug 6.

Authors

Affiliations

¹ Institute of Cardiometabolism and Nutrition, Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Paris, France.
² Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP) Hôpital Pitié-Salpêtrière, Paris, France.
³ Interdisciplinary Medical Intensive Care, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg im Breisgau, Germany.
⁴ Division of Pulmonary, Allergy and Critical Care Medicine, NewYork-Presbyterian / Columbia University Irving Medical Center, New York, NY, USA.
⁵ Department of Emergency Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Division of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA.
⁶ Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁷ Centre for Human and Applied Physiological Sciences, School of Basic & Medical Biosciences, King's College London, London, UK.
⁸ Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁹ Management, and Evaluation, Institute of Health Policy, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada.
¹¹ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
¹² University of Queensland, Brisbane, Australia.
¹³ Queensland University of Technology, Brisbane, Australia.
¹⁴ Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia.
¹⁵ Wesley Medical Research, Brisbane, Australia.
¹⁶ School of Medicine, Griffith University, Brisbane, Australia.
¹⁷ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
¹⁸ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁹ Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia.
²⁰ University of Melbourne, Parkville, VIC, Australia.
²¹ Department of Anaesthesiology and Critical Care Medicine B (DAR B), PhyMed Exp, INSERM U1046 Montpellier, Saint-Eloi Hospital, University Teaching Hospital of Montpellier, University of Montpellier, Montpellier, France.
²² Cardiothoracic ICU, National University Hospital, Singapore, Singapore.
²³ Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK.
²⁴ Department of Critical Care Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁵ Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, FL, USA.
²⁶ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
²⁷ Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
²⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA. DanielBrodie@jhu.edu.

^# Contributed equally.

PMID: 40768066
DOI: 10.1007/s00134-025-08070-1

Abstract

Extracorporeal Life Support (ECLS), including venovenous (VV) extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R) is a temporary support option for patients with severe respiratory failure. Current data and recent guidelines support the use of VV ECMO for select patients with very severe respiratory failure as this technique might improve survival in appropriately selected patients. Patient selection criteria, timing of ECMO initiation and optimal management of mechanical ventilation and anticoagulation, and other adjunctive treatment options are a matter of ongoing research.

Keywords: ARDS; Acute respiratory distress syndrome; ECCO2R; ECLS; Extracorporeal carbon dioxide removal; Extracorporeal life support; VV ECMO; Venovenous extracorporeal membrane oxygenation.

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Conflict of interest statement

Declarations. Conflicts of interest: All authors have completed the ICMJE form (available upon request from the corresponding author). AC reports honoraria for lectures from Getinge and Baxter. AS reports research grants and honoraria for lectures from CytoSorbents Europe, honoraria for lectures from AstraZeneca, Johnson&Johnson, Getinge and Resuscitec, travel support and consulting fees from ARTCLINE and consulting fees from LAUDA Medical, all outside the submitted work. He is a member of the scientific committee of EuroELSO and serves as the co-chair of the section for respiratory failure of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI). DA writes for UpToDate. CA reports travel support and a waiver of congress participation fees by EuroELSO, and she is a member of the ELSO conference committee and of the North American ECMONet steering committee. LC received honoraria for lectures from Medtronic, he is a member of a DSMB for Novartis and a member of the scientific committee of ECMONet, he received equipment for research from Johnson&Johnson. EF reports consulting fees from Aerogen, Baxter, Getinge, Boeringer Ingelheim, Inspira, Mallinckrodt and Vasomune and research grants from CIHR, PISF and NIH. NDF reports consulting fees from Baxter Inc. He is the President and Chair of the Organizing Committee for Critical Care Canada Forum and a Board Member of the International ECMO Network. He receives grant funding from the Canadian Institutes of Health Research, paid to his institution. He participates on Data Safety Monitoring Boards for international trials funded by the NIH (USA) and NIHR (UK)—all outside the submitted work. JFF reports research grants from Fresenius, Fisher and Paykel Healthcare and Mallinckrodt, consulting fees from the Office of the Health Ombudsman, lecture fees from Mallinckrodt and the Korean Society of Critical Care Medicine—ACCC, travel support and support for attending meetings from Fresenius, Fisher and Paykel Healthcare and Mallinckrodt, payments from Mallinckrodt for participation on medical advisory boards, provision of medical equipment from Fresenius, he is Founder and Chief Medical Officer of De Motu Cordis, Co-Chair of the International ECMO Network, Board Director of the Australian Cardiovascular Research Alliance, and Clinical Director of the Queensland Spatial Biology Centre, and he holds stocks from BiVACOR and De Motu Cordis. GM is the Past President of ELSO. BVP received honoraria for lectures from Medtronic, he is a member of a DSMB for Novartis and a member of the scientific committee of ECMONet, he received equipment for research from Johnson&Johnson. GJP reports memberships in the ELSO Guidelines Sub-Committee, ELSO Membership Committee, ELSO Bedside Guide working Group, ELSO Communications Committee, ELSO Scientific Committee, and ELSO E-NPEC working group. MS reports honoraria for lectures from Getinge, Fresenius Medical Care, and Solventum. ASS has consulted for Cellenkos, Draeger, Stimit, and Vantive. He is Co-chair of the Scientific Committee of ECMONet. DB consults for LivaNova. He has been on the medical advisory boards for Medtronic, Inspira, Cellenkos, HBOX Therapies and Vantive. He is the President of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Board of the International ECMO Network (ECMONet), and he writes for UpToDate. The other authors declare no competing interests. Samir Jaber is the Editor in Chief of Intensive Care Medicine. Carol Hodgson is a Section Editor for Intensive Care Medicine. Neither Samir Jaber nor Carol Hodgson have not taken part in the review or selection process of this article. Ethical approval: For this review article ethical approval was not required.

References

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Extracorporeal life support for adult patients with ARDS

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Extracorporeal life support for adult patients with ARDS

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