A total of 13 patients were treated with ECMO for ARDS: six patients were affected by bacterial pneumonia, five patients had H1N1-related ARDS (two with Legionella Pneumophila superinfection), and 2 patients presented trauma-related respiratory failure. Data of each patient are represented in Table 1 . Median age was 59 years (IQR 44-65), with a prevalence of male sex (85%). Median ICU length of stay was 17 days (IQR [13] [14] [15] [16] [17] [18] [19] [20] . Eight out of 13 patients were successfully weaned from ECMO and discharged from ICU (overall survival rate of 62%). All H1N1 patients were discharged from ICU and from hospital. The median duration of ECMO was 235 hours (IQR 151-269), with a difference between survivors (221 hours) and non survivors (257 hours). We considered time from verification of ECMO criteria to extracorporeal support start as an efficiency parameter ("time to ECMO"), and it was 6 hours (IQR 4-9). From October 2009, when our ECMO Service became the referral centre of Central Italy for H1N1-induced ARDS, extracorporeal support was initiated in the peripheral hospital in 3 cases. Inter-hospital transport was safely performed on extracorporeal support and all patients were discharged alive from ICU. One young patient (19 years) died due to severe traumatic brain injury. In this patient, ECMO was maintained in the first 12 hours without systemic heparin infusion and no complications occurred during extracorporeal treatment. After cerebral death confirmation, multiple organ donation was accomplished. One patient (a 64 year-old woman) died due to subarachnoidal hemorrhage, although coagulation parameters were normal. 