Veno-venous extracorporeal membrane oxygenation (ECMO) is a life-saving technique in the armamentarium of critical care medicine. It involves extracorporeal blood circulation outside the body, providing temporary respiratory support while allowing the lungs to heal. Traditionally, patients undergoing ECMO require sedation to minimize discomfort and facilitate mechanical ventilation. The “awake ECMO” concept emerged as a promising strategy to mitigate sedation-related complications and facilitate early mobilization in critically ill patients. In this article, we describe the potential advantages of awake ECMO and its role in preserving respiratory muscle function, enhancing rehabilitation prospects, and improving patient outcomes.

ECMO is a cutting-edge life-support measure for critically ill patients, particularly those with severe acute respiratory failure, such as acute respiratory distress syndrome (ARDS). Veno-venous ECMO (VV ECMO) is the configuration of choice in respiratory failure with preserved heart function, offering a lifeline by providing temporary respiratory support while “buying time” for the lungs to heal.