TY - JOUR T1 - Extracorporeal support for patients with acute respiratory distress syndrome JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 379 LP - 389 DO - 10.1183/09059180.00005514 VL - 23 IS - 133 AU - Simon J. Finney Y1 - 2014/09/01 UR - http://err.ersjournals.com/content/23/133/379.abstract N2 - Extracorporeal membrane oxygen (ECMO) has been used for many years in patients with life-threatening hypoxaemia and/or hypercarbia. While early trials demonstrated that it was associated with poor outcomes and extensive haemorrhage, the technique has evolved. It now encompasses new technologies and understanding that the lung protective mechanical ventilation it can facilitate is inextricably linked to improving outcomes for patients. The positive results from the CESAR (Conventional ventilation or ECMO for Severe Adult Respiratory failure) study and excellent outcomes in patients who suffered severe influenza A (H1N1/09) infection have established ECMO in the care of patients with severe acute respiratory distress syndrome. Controversy remains as to at what point in the clinical pathway ECMO should be employed; as a rescue therapy or more pro-actively to enable and ensure high-quality lung protective mechanical ventilation. The primary aims of this article are to discuss: 1) the types of extracorporeal support available; 2) the rationale for its use; 3) the relationship with lung protective ventilation; and 4) the current evidence for its use. ER -