Venovenous ECMO (a Sorin Revolution centrifugal pump, a Sorin ECCO oxygenator and a Sorin Satcrit console from Sorin Group, Milano, Italy) was put in place on the fifth day of hospitalization, with a left femoral 22-Fr drainage cannula and a right femoral 23-Fr return cannula, inducing a drastic improvement of our patient's oxygenation parameters (PaO 2 = 120 mmHg). The mixed venous oxygen saturation (SVO 2 ) increased from 56% to 86%. Continuous veno-venous hemodiafiltration (CVVHDF) renal replacement therapy was also initiated on day three because of acute renal failure.