Acute Respiratory Distress Syndrome (ARDS) is a life-threatening condition, first described in 1967.1 57 years later, ARDS is one of the leading causes of acute respiratory failure and remains associated with a high mortality rate, ranging from 34 to 46%.2 Annually, ARDS impacts about 3 millions of patients worldwide, with about 200,000 cases reported in the United States each year, resulting in nearly 75,000 deaths.3
Despite decades of research, the management of ARDS remains supportive. In fact, more than 150 RCTs were conducted since ARDS first description. To date, no specific pharmacologic therapies have been successfully developed and only few interventions have resulted in a significant reduction in mortality rate. Protective mechanical ventilation and prone positioning currently represent the cornerstone of ARDS management. However, some patients are refractory to optimal conventional management. In life-threatening situations, ECLS has been proposed as a potential rescue strategy. Since the first successful case described in 1972,4 and after several negative trials, ECMO has finally become an established treatment for refractory ARDS. In fact, recent guidelines advocate for its use in selected patients and high-volume centers (strong recommendation, moderate level of evidence).5
This thesis aims to review the historical perspective and evidence supporting the use of VV- ECMO in the management of ARDS. The introduction is divided into two parts. The first part will introduce ARDS, and the second part will focus on the aims, key principles, historical perspective and evidence associated with this technique in ARDS. Then, a line of work will present and highlight the methodological limitations of RCTs conducted in ARDS, the impact of the timing of implantation of ECLS in ARDS, the maternal and fetal outcome of pregnant patients rescued with ECMO in severe ARDS, and the management of mechanical ventilation during ECMO support. Finally, based on these findings, the research agenda will be reviewed and discussed.
