Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular.

Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as “awake ECMO”) may have potential advantages, including lower rate of delirium, shorter mechanical ventilation time, and possibility to undergo early rehabilitation/physiotherapy.

Management of awake, spontaneous breathing patients under V-V ECMO is a challenging task.

Multidisciplinary team cooperation and patient-tailored planning are fundamental to running a safe awake V-V ECMO program.

Before the initiation of awake V-V ECMO support, careful patient selection is needed.

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