• Alain Combes, Daniel Brodie, Robert Bartlett, Laurent Brochard, Roy Brower, Steve Conrad, Daniel De Backer, Eddy Fan, Niall Ferguson, James Fortenberry, John Fraser, Luciano Gattinoni, William Lynch, Graeme MacLaren, Alain Mercat, Thomas Mueller, Mark Ogino, Giles Peek, Vince Pellegrino, Antonio Pesenti, Marco Ranieri, Arthur Slutsky, Alain Vuylsteke, and International ECMO Network (ECMONet).
• 1 Institute of Cardiometabolism and Nutrition, Groupe Hospitalier Pitié-Salpêtrière, Pierre Marie Curie University, Paris, France.
• Am. J. Respir. Crit. Care Med. 2014 Sep 1; 190 (5): 488-96.

AbstractThe use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.

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