Extracorporeal life support and unconventional mode of respiratory management

Acute respiratory failure is very common in interstitial lung diseases and optimal ventilatory management in this setting is still under investigation. The dismal prognosis of patients needing mechanical ventilation urged the search for alternative strategies, such as extracorporeal life support. Since its first use as a bridge to lung transplant, extracorporeal membrane oxygenation (ECMO) improved its technology and results. Despite available data on the topic mostly derive from small non-homogeneous case series or reports, usually with a single center setting and a retrospective design, the literature shows that the use of ECMO bridging transplants has risen. Clinical success is more related to appropriate candidacy and timely deployment rather than to device-specific complications. Anyway, further efforts need to be done to improve outcomes and to increase the bridge to transplant/bridge to no-where ratio.