Key messages

• All conventional methods of maintaining adequate gas exchange in acute respiratory distress syndrome are potentially harmful to the residual healthy lung.

• The rationale for extracorporeal respiratory support is based on the assumption that lung rest provides a better environment for healing.

• Extracorporeal respiratory support should still be considered as an experimental technique which should be concentrated in a few referral centers with sufficient motivation, technical skills, and staff to test new technical solutions safely.

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