exhaled air is exhausted to outdoors through filters, fresh air comes in. different tubes for different direction of air flow
I've also ready some hospitals are using techniques were O2 levels are increased directly in the blood supply? I can't remember what that's called though.
ECMO [1], it has been used quite a bit in Italy too.
[1] https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...