60 years of ARDS and the evolution of extracorporeal lung support - from ECMO to ECCO<sub>2</sub>R.

Fernando, Shannon M; Brodie, Daniel; Slutsky, Arthur S; Abrams, Darryl; Agerstrand, Cara; Camporota, Luigi; Fan, Eddy; Ferguson, Niall D et al. · Intensive Care Med · 2026

review · Level V

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Abstract

Extracorporeal life support (ECLS), including venovenous extracorporeal membrane oxygenation (VV-ECMO) and extracorporeal carbon dioxide removal (ECCO₂R), is an established treatment for selected patients with acute respiratory distress syndrome (ARDS). In this review, on the 60th anniversary of ARDS, we review the evolution of ECLS as a support strategy in ARDS, the evidence surrounding its efficacy, factors associated with prognosis, management of patients on ECLS, associated complications, and long-term outcomes among survivors. We also highlight existing areas of uncertainty, and ongoing clinical research that will define the next decade and beyond of ECLS for ARDS.