ECMO Escalation in ARDS: Prevalence, Mortality, and Hospital Volume Impact

For patients with severe acute respiratory distress syndrome (ARDS), venovenous extracorporeal membrane oxygenation (VV ECMO) is an established therapy for profound hypoxemic respiratory failure [1, 2]. While effective for isolated pulmonary dysfunction, a subset of these patients subsequently develops severe cardiogenic shock, creating a complex clinical challenge [3]. This deterioration necessitates escalating support to a configuration that provides both cardiac and respiratory assistance, a decision with significant implications for patient survival [4]. A clear evidence base is needed to guide clinicians on the prevalence of this event, the factors that predict it, and the outcomes associated with different escalation strategies [5, 6].