**5. Conclusion**

The COVID-19 pandemic has presented the most unparalleled global healthcare challenge since the influenza pandemic of 1918. Our knowledge of the disease and potentially efficacious therapy is constantly evolving, and yet patients with COVID ARDS remain at significantly increased risk of poor outcomes, including mortality. Although ECMO is a possible lifesaving option in those who are refractory to optimal conventional therapy, it is still unclear whether the use of VV ECMO definitively confers improved survival in patients with COVID-19 ARDS based on the mortality data thus far, although the more recent data is encouraging. We do know however, that improved survival depends on numerous factors, including resource allocation,

patient selection criteria, timing of ECMO initiation, and centre volume experience. Judicious and ethical patient selection is therefore paramount to ensure the greatest benefit and least harm in the face of a constrained healthcare environment with finite resources.
