Extracorporeal support of the respiratory system

In the last 20 years there have been significant advances in extracorporeal support of the respiratory system. What once was a highly complex intervention, undertaken as a salvage procedure in a handful of patients, has become more wide spread, both in terms of availability and underlying indications. We review the principles of equipment; physiological control of oxygenation and decarboxylation; associated complications; and role in clinical practice. The evidence for extracorporeal life support in this rapidly evolving field of organ support is critiqued.