32. VV-ECMO Roundtable

VV-ECMO provides essential respiratory support for patients with severe, reversible respiratory failure, particularly ARDS, by oxygenating blood and removing carbon dioxide through an extracorporeal circuit. While the EOLIA trial demonstrates a potential mortality benefit for severe ARDS, the magnitude of this effect remains debated, necessitating a balanced approach that prioritizes optimal medical management—such as prone positioning and lung-protective ventilation—before initiating invasive support. Clinicians must carefully weigh the risks of bleeding and thrombosis against the clinical necessity of the intervention. Beyond ARDS, VV-ECMO serves as a critical bridge to lung transplantation, allowing patients to remain awake and mobile. Successful implementation relies on a multidisciplinary team approach, regionalized care networks, and rigorous patient selection to ensure that this resource-intensive therapy is deployed effectively for those most likely to recover.