The present case series comprises a small number of patients, and naturally, it cannot be considered a high grade of evidence trial. However, our experience might be helpful for intensivists challenging H1N1-induced ARDS. For H1N1 infection monitoring (or diagnosis, if patient was intubated before) bronchoalveolar lavage can be more reliable than pharyngeal swab in order of the higher sensitivity. In our clinical practice, ECMO therapy resulted safe and feasible in the context of a life threatening condition, and it might be taken into consideration as a therapeutic choice rather than a rescue solution in experienced centers.