Surfactant therapy and extracorporeal life support

I read with great interest the article by Hermon and coworkers [1], who reported that surfactant application in children with severe respiratory failure treated with extracorporeal membrane oxygenation was associated with improved lung volume and pulmonary mechanics. Although these findings must be confirmed in prospective studies, they are very promising. Based on a series of animal studies, more than 10 years ago we advocated use of a combination of surfactant therapy and extracorporeal life support in the treatment of severe respiratory failure. We found that one effective option is to combine intratracheal instillation of a large fluid volume with diluted surfactant and LFV-ECCO2R (low frequency ventilation and extracorporeal carbon dioxide removal).