60 years of ARDS and the evolution of extracorporeal lung support – from ECMO to ECCO2R

 

Intensive Care Medicine  Published: 07 July 2026

 

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.