Refractory hypoxemia on venovenous ECMO
Despite numerous advances in the care of patients with Acute Respiratory Distress Syndrome (ARDS), severe cases still carry extreme mortality and dismal odds for survival [1]. This has driven a search over the years for rescue therapies when convential mechanical ventilation fails [2], culminating in an expansion in the use of venovenous extra-corporeal membrane oxygenation (VV-ECMO) on the heels of the successful French H1N1 experience and the CESAR trial [3, 4]. While the efficacy of this unconvential therapy is still a matter of debate, and the recent EOLIA trial creates further doubt [5, 6], there remain cases of ARDS refractory to even venovenous (VV) support. In this chapter, we will review the expected utility of VVECMO as well as salvage therapies when hypoxemia overwhelms extra-corporeal support and ability.
