Using extracorporeal membrane oxygenation (ECMO) as rescue respiratory support for COVID-19 related ARDS may be seen as a controversial use of scarce and stretched resources in the context of a global pandemic. We present two cases of COVID-19 related ARDS both requiring ECMO support in an experienced ECMO tertiary centre. The cases illustrate the decision-making concerning the initiation of ECMO during lifethreatening COVID-19 related respiratory failure. Both patients encountered the typical complications during extensive ECMO support, but with a completely different outcome. To identify patients that really benefit from this potentially life-saving support modality and attain meaningful functional outcome in addition to survival, remains a matter of debate.
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