40 years of ECMO 
What have change is understanding of MV
🫁 Focus on protection
🫁 Focus on protection
VV ECMO
Indications
Oxygenation and time
Oxygenation and time
Benefits of ECMO in ARDS
🫁 Reducing mechanical ventilation
🫁 Reducing mechanical ventilation
ECMO allows ultra protective ventilation
Reduction of driving pressure is very important
One cm of driving pressure 16% increase in mortality🤯
Low RR and inflammation
Driving pressure and injury
ECMO in COVID
ECMO and mortality
High volume centers 3x better outcomes
Extracorporeal CO2 removal
What blood flow is best?
REST trial in JAMA
🫁 No difference
ECCO2R Higher risk of ICH 🩸
The study was underpowered
🫁 No difference
ECCO2R Higher risk of ICH 🩸
The study was underpowered
Conclusions
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