Conclusions
Our experience shows that adequate planning of veno-venous ECMO cannulation allows safe completion of the procedure at bedside. This strategy can be particularly useful in patients with refractory hypoxemia due to COVID-19 associated severe ARDS as bedside cannulation can minimize the inadvertent nosocomial transmission of this highly contagious disease. Veno-venous ECMO management is resource-intensive and limited to specialized referral centers but can be used as salvage therapy in patients with refractory respiratory failure who have preserved life-expectancy and few associated end-organ failures. Certainly, we acknowledge the ethical dilemma of patient selection for access to life-sustaining extracorporeal support during this pandemic. Nonetheless, the opportunity of saving even a relatively small number of patients in comparison to the large loss of lives produced by this highly lethal disease cannot be ignored.