Extracorporeal Gas Exchange: Indications and Implementation.

Mortality in patients with acute hypoxemic respiratory failure remains high at 40% to 50%. It is now recognized that intensity of mechanical ventilation has a significant contribution. Extracorporeal support enables effective gas exchange while allowing lung-protective ventilation that may not be achievable with conventional ventilation. Accurate diagnosis on extracorporeal membrane oxygenation is crucial, requiring a broad, systematic assessment of respiratory failure cause, key contributors, and complications. Initial evaluation includes thoracic imaging, microbiology, inflammatory markers, autoimmune tests when appropriate, and echocardiography to exclude structural causes.