RESPIRATORY SYSTEM: Edited by Michael Quintel and Luciano GattinoniWhen the momentum has gone: what will be the role of extracorporeal lung support in the future?Abrams, Darryla; Bacchetta, Matthewb; Brodie, DanielaAuthor Information aDivision of Pulmonary, Allergy and Critical Care bDepartment of Surgery, Columbia University College of Physicians and Surgeons, New York, USA Correspondence to Daniel Brodie, MD, Associate Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, 622 W168th Street, PH 8E, 101, New York, NY 10032, USA. Tel: +1 212 305 9817; fax: +1 212 305 8464; e-mail: firstname.lastname@example.org Current Opinion in Critical Care: February 2018 - Volume 24 - Issue 1 - p 23-28 doi: 10.1097/MCC.0000000000000475 Buy Metrics Abstract Purpose of review There has been expanding interest in and use of extracorporeal support in respiratory failure concurrent with technological advances and predominantly observational data demonstrating improved outcomes. However, until there is more available data from rigorous, high-quality randomized studies, the future of extracorporeal support remains uncertain. Recent findings Outcomes for patients supported with extracorporeal devices continue to show favorable trends. There are several large randomized controlled trials that are in various stages of planning or completion for extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R) in the acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD), which may help clarify the role of this technology for these disease processes, and which stand to have a significant impact on a large proportion of patients with acute respiratory failure. Novel applications of extracorporeal lung support include optimization of donor organ quality through ex-vivo perfusion and extracorporeal cross-circulation, allowing for multimodal therapeutic interventions. Summary Despite the ongoing rise in ECMO use for acute respiratory failure, its true value will not be known until more information is gleaned from prospective randomized controlled trials. Additionally, there are modalities beyond the current considerations for extracorporeal support that have the potential to revolutionize respiratory failure, particularly in the realm of chronic lung disease and lung transplantation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.