Possibilities and Considerations on the Use of ECMO as a Therapeutic Option for Patients with Acute Respiratory Distress Syndrome due to Viral Infections

Management of acute respiratory distress syndrome due to viral outbreaks includes lower tidal volumes, lower inspiratory pressure, prone ventilation, and conservative fluid management. Extracorporeal membrane oxygenation (ECMO) has been proposed as rescue therapy in critically ill patients. However, in the absence of larger studies, the role of ECMO in reducing patient mortality rates remains unclear since studies that reported such effect, both during the current as well as during previous outbreaks, were based on small sample sizes, and their results are inconsistent. Furthermore, the use of ECMO might even be contraindicated in the presence of some conditions. Recurring to it has, therefore, to be discussed by qualified multi-disciplinary teams and based on a case-by-case strategy.