During ARDS, ECMO is seen as the standard therapy to improve oxygenation. The CESAR study demonstrated that in highly specialized centers, ECMO therapy may improve long-term outcome. However, this study had limitations within the study design, because the intervention and control group were treated at different centers [5] . In a review of 62 cases with ECMO therapy, the survival rate was 55% [6] ; 17.8% of patients died as a result of ECMO-related complications, translated into a mortality of 8% due to ECMO alone. A retrospective U. S. database analysis (1986-2006) demonstrated a mortality rate of 50% in patients treated with ECMO. Although technical improvement of ECMO equipment translated into fewer cases of circuit rupture, renal insufficiency, pulmonary hemorrhage, inotropic medications, hyperglycemia, extremes of pH, arrhythmias, or hypertension became more common [7] .