Predicting outcome of venovenous ECMO: look outside the lung!

As a background, we acknowledge that the mortality rate of patients with severe acute respiratory distress syndrome (ARDS) is still elevated, exceeding 50% despite optimal supportive care (1-3) and that patients who survive have a worse quality of life in terms of functional, physical and psychological performances. Indeed, as long as we speculate in this setting, we assume to deal with patients who do not have life-threatening hypoxemia, as in this regard there would be no point against venovenous extracorporeal membrane oxygenation (VV ECMO).