ELSO Adult ECMO 2021 — ELSO Guidelines for Adult Extracorporeal Life Support

ELSO guidance supports considering VV-ECMO for selected patients with severe, potentially reversible respiratory failure despite optimized conventional management. EOLIA trial entry criteria included PaO2/FiO2 <50 mmHg for >3 h, PaO2/FiO2 <80 mmHg for >6 h, or pH <7.25 with PaCO2 >=60 mmHg for >6 h despite optimized ventilation. These trial thresholds should not be presented as universal stand-alone indications. During ECMO, use a lung-protective or lung-rest strategy individualized to mechanics and gas-exchange goals rather than fixed PEEP, respiratory-rate, driving-pressure, or tidal-volume numbers for every patient.