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 Extracorporeal Membranous Oxygenation (VV ECMO) has been employed to treat this very
sick group 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.
Keywords: ARDS, avalon, cardiohelp, ECMO, PEEP, refractory hypoxia.
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