The role of extracorporeal membrane oxygenation (ECMO) in supporting adult refractory respiratory failure continues to evolve. Technical advances and the clinical challenges of H1N1 associated severe ARDS have spurred a resurgence of interest in ECMO. Published systematic review and pooled analyses point out the limitations of available studies, however, a growing body of evidence suggest potential for benefit. Referral to a specialized center with ECMO experience should be considered early after the initiation of high-level ventilator support in adult patients with severe ARDS.
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