Referral to specialized center for venovenous (VV) ECMO treatment should be considered expeditiously in case of refractory ARDS, which is often lethal. Transport of unstable patients, although challenging, is feasible and centralization of patients is associated with good outcomes.

Observational study on 100 patients treated from May 2009 to November 2020 in a referral center in Italy.

Mean age was 54 ± 14 years and 65% of patients were male. Patients were treated in every time of the year with seasonal peaks in winter months.

The vast majority of patients was referred from hospitals within the Lombardia Region (81%), mainly from Milan city and surrounding area (36% of the total).

Most frequent etiology of refractory ARDS was H1N1Influenza A (42 pts, 42%), followed by bacterial pneumonia with 35 cases (35%) and Sars-CoV-2 infection in 5 (5%).

All patients were severly hypoxic at time of VV ECMO treatment.

No transport related complication was recorded. The most common configuration utilized in our clinical practice was bicaval dual-lumen configuration with 61 patients (61%), followed by femoro-jugular configuration in 38 (38%). ICU survival rate was 55%.

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