The availability of easily accessible tools for pulmonary mechanics evaluations on modern ventilators allowed an individualized and appropriate setting of ventilation pressure within the thresholds of so called "protective ventilation" [23] . Furthermore, early access to ECMO resource allowed the maintenance of protective ventilation even in more severe patients (Table 4 ). In this regard, lactate dehydrogenase is commonly considered a marker of lung damage, and in H1N1 pneumonia is reported as high [1] . In our ECMO patients, lactate dehydrogenase values presented lower levels than in non-ECMO patients (445 U/L vs 627 IU/L, respectively), suggesting that in ECMO patients the reduced need of pulmonary ventilation could reduce lung ventilatory stress and enhance healing, regardless of the more impaired lung condition.