A total of 21 patients were treated with ECLS during the first one year of activity (April 2008 -December 2009). Among them, 13 were treated with ECMO for respiratory failure (Table 1) , and 8 were treated with V-A ECLS due to cardiac arrest ( Table 2 ) and cardiogenic shock ( Table  3 ). The most frequent complication observed was local bleeding from the insertion points of the cannulae, central line access site and tracheostomy (36%). In one case, oxygenator failure occurred due to clots formation; in this occasion a rapid increase of D-Dimers was observed, followed by a worsening of oxygenation and decarboxylation performance of the artificial lung. Circuit change was promptly carried out with no further complications. In one case of V-A ECLS, major bleeding occurred at site of cannulae insertion several days after successful wean-ing, requiring multiple transfusions. At surgical inspection a femoral artery wall lesion was found and required prosthetic repair. Five patients received renal replacement therapy (continuous veno-venous hemofiltration, CVVH). The CVVH was connected in-line to the extracorporeal circuit with the withdrawal line before oxygenator and return line after the oxygenator. Renal function recovered in all cases, and both ECLS and CVVH run was uneventful on this configuration. During extracorporeal support, invasive procedures were carried out without any immediate complications. Among these, four bedside percutaneous tracheotomies (Ciaglia technique) were performed, and two narrow bore pleural catheters were inserted under ultrasound guidance for massive pleural effusions. Autopsy was performed in all non surviving patients and no lesion of vessels due to the presence of cannulae was observed.