ELSO guidelines development: A roadmap

The Extracorporeal Life Support Organization (ELSO) has progressively transformed its guideline framework to meet the increasing clinical, scientific, and operational demands of modern extracorporeal life support. Since its establishment in 1989, ELSO has supported Extracorporeal Membrane Oxygenation (ECMO) programs worldwide through education, data reporting, and consensus-building. Recent expansions in ECMO utilization, coupled with rapidly growing evidence, have necessitated a more structured, transparent, and internationally representative approach to guideline development.In 2023, ELSO expanded the Guideline Subcommittee (GSC) to ensure participation from all ELSO chapters and key professional disciplines. This expansion enables the implementation of a standardized workflow encompassing proposal submission, methodological review, authorship requirements, external peer review, plagiarism screening, and final Board approval. The updated process emphasizes consistency, timely production, and methodological rigor across all ELSO guidelines.This manuscript summarizes the current ELSO guideline development process and highlights four recently published guidelines addressing early mobility, adult neuromonitoring, ECMO in pregnancy and the peripartum period, and accidental hypothermia. Each guideline reflects the available evidence integrated with multidisciplinary expert input, with the goal of providing globally applicable, practical recommendations for ECMO clinicians. The review also outlines the formal guideline update cycle and ELSO's expanding collaborations with international societies to produce joint guidance documents.As ECMO practice continues to evolve, ELSO remains committed to advancing high-quality, accessible guidelines that support consistent standards of care across diverse healthcare systems. Future priorities include guidelines on ECMO during cardiopulmonary resuscitation, trauma, and other high-impact clinical areas, along with enhanced education and training pathways to strengthen ECMO practice globally.