Begin treatment for the underlying cause of ARDS including the standard lung-protective ventilation strategy and diuresis or resuscitation as appropriate.

Note: Respiratory ECMO can be indicated in several specific clinical conditions, but this section will only address ARDS.

Specific clinical conditions include:

Acute respiratory distress syndrome (ARDS) (e.g., viral/bacterial pneumonia and aspiration)
Diffuse alveolar hemorrhage or pulmonary hemorrhage
Severe asthma
Thoracic trauma (e.g., traumatic lung injury and severe pulmonary contusion)
Severe inhalational injury
Large bronchopleural fistula
Peri-lung transplant (e.g., primary lung graft dysfunction and bridge to transplant)