ECMO during the COVID-19 pandemic: When is it justified?

Abrams et al. recently introduced their view of extracorporeal membrane oxygenation (ECMO) utilisation during the COVID-19 pandemic as a burden-based approach, highlighting that surge conditions may result in decreased utilization of ECMO, as resources must be carefully managed to ensure an acceptable level of care in all patients [1]. Whilst case numbers may overwhelm some health care systems, thus making ECMO seem less attractive, we are offering an extended viewpoint where ECMO may be justified if systems are optimised to proceed without compromising the overall delivery of intensive care (Fig. 1).