Veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome: should the EOLIA Study results change our clinical approach?

The original discouraging results of extracorporeal membrane oxygenation (ECMO) application in acute respiratory failure caused the technique to be almost abandoned. Fortunately, ECMO survived thanks to the good results obtained in neonates. The interest on ECMO renewed after the publication of the CESAR Trial in 2009. The ultimate rebirth of the technique, however, was due to its use as a rescue therapy in severely hypoxemic patients untreatable with conventional methods during H1N1 flu epidemics in Australia and New Zealand. In 2018 the group of investigators led by Alain Combes designed and implemented the EOLIA Study to test the efficacy of veno-venous ECMO in patients with severe acute respiratory distress syndrome (ARDS). This article discusses the primary and secondary results of the trial and the considerations emerged in the medical community. We will also discuss how ECMO could evolve to maximize lung protection rather than just prevent hypoxic death.