Beyond Rescue: The Evolving Role of ECMO in Life and Organ Support

Extracorporeal membrane oxygenation (ECMO) has progressed from a last-resort rescue therapy for refractory respiratory or circulatory failure to a versatile platform integrated into modern critical care. Both veno-venous and veno-arterial modalities are now applied across diverse clinical scenarios, ranging from severe acute respiratory distress syndrome to cardiogenic shock. Recent advances have extended ECMO’s role into the perioperative management of complex organ transplantation and, more recently, as a bridge to organ donation in patients with catastrophic brain or circulatory injury. This expansion raises new clinical, ethical, and logistical questions while offering unprecedented opportunities to improve survival and optimize the use of scarce donor organs.

This collection aims to provide a comprehensive exploration of ECMO’s evolving role beyond conventional rescue therapy, highlighting its integration into organ support and transplantation pathways. We seek to capture the latest evidence on indications, patient selection, and long-term outcomes of both veno-venous and veno-arterial ECMO, as well as its application in liver, lung, and heart transplantation. Equally important, the issue will address ECMO as a bridge to organ preservation and donation, an area of growing significance in light of global organ shortages.

Through original research, systematic reviews, case series, and thought-provoking case reports, we aim to present not only the successes but also the limitations and controversies of ECMO. By assembling diverse perspectives from intensivists, anesthesiologists, surgeons, and ethicists, this collection intends to inform practice, stimulate debate, and guide the responsible expansion of ECMO in both patient- and organ-centered care.