A recent Italian experience, in patients with ARDS due to the influenza A/H1N1 virus, based on pre-emptive patient centralization showed a 77% survival rate if ECMO was started within seven days of initiation of mechanical ventilation [11] . Indication for ECMO in this study was refractory hypoxia or an oxygenation index below 30 despite a PaO 2 /FiO 2 ratio greater than 100 mmHg.