I would be remiss to write about COVID in the intensive care unit without mentioning ECMO (extracorporeal membrane oxygenation) and lung transplant. These are extraordinary measures we might consider as a last-ditch effort in life-threatening COVID. They have been used successfully, but involve significant risk and potential harm to patients. I do not work in a center that provides ECMO or lung transplant, so we have to refer patients who may be candidates to other hospitals. I won't write a long blog because my experience is limited to the process of candidate selection and referral. But overall, I believe unfortunately, these are not miracle interventions that we can depend on. Resources and capacity are very limited, and although I have referred many patients for these possibilities, far more of our referral requests are declined than accepted. Realistically, we cannot count on them as a solution to life-threatening COVID.