Acute respiratory distress syndrome (ARDS) is one of the major causes of ICU deaths. Extracorporeal lung
assist (ECLA) has been used as a rescue therapy for most severe form of ARDS. However, its survival benefit had not
been shown until CESAR trial in 2009. This has been because the concept of lung protective ventilation strategy had not
yet known. Since CESAR trial, the clinical application of ECLA for ARDS as a method to achieve lung rest has wide
spread. The effectiveness is further appreciated during the 2009 H1N1 influenza pandemic. The succeeded countries
achieved building the transportation systems to collect ECLA patients. With the accumulating evidences of survival
benefit, the long-term outcome such as pulmonary function and quality of life are in concern. PumplessECLA which is a
newly developed form of ECLA is also reviewed. In this essay we will firstly review the basics of ARDS and ECLA.
Then the historical development of ECLA evidences for ARDS are reviewed.