ECMO can also serve as a salvage measure for severely ARDS children who have failed conventional mechanical ventilation treatment. When optimizing ventilator parameters (titrating positive end expiratory pressure (PEEP) levels, neuromuscular blockers, prone positioning), strict fluid management alone cannot maintain satisfactory oxygenation (P/F\<80mmHg or Oxygen Index (OI) \>40 for over 4 hours or OI \>20 for over 24 hours), initiating ECMO can achieve lung-protective ventilation strategies with ultra-low tidal volumes to minimize ventilator-associated lung injury. conditions: Pediatric Acute Respiratory Distress Syndrome conditions: Extracorporeal Membrane Oxygenation studyType: INTERVENTIONAL phases: NA allocation: RANDOMIZED interventionModel: PARALLEL primaryPurpose: TREATMENT masking: NONE count: 7 type: ESTIMATED name: prone position measure: Mortality measure: Failure of supine position measure: ECMO successful weaning rate measure: Total duration of ECMO Support measure: Number of ECMO-free days measure: Duration of mechanical ventilation days after ECMO successful weaning. measure: Duration of Pediatric Intensive Care Unit (PICU) stay. measure: Duration of hospitalization measure: Incidence of brain injury before discharge measure: Number of days with organ failure measure: Number of days alive without organ failure measure: Number of ventilator assist pneumonia, bacteriemia, and cannula infection episodes measure: Number of days with hemodynamic support with catecholamines measure: Number of days without hemodynamic support with catecholamines sex: ALL minimumAge: 1 Month maximumAge: 18 Years stdAges: CHILD stdAges: ADULT facility: seventh medical center of Chinese PLA General Hospital city: Beijing state: Beijing zip: 100700 country: China name: Xiaoyang Hong, M.D. role: CONTACT phone: 13311057633 email: jyhongxy@163.com name: Zhe Zhao role: CONTACT phone: 18500179885 email: derekpicu@outlook.com lat: 39.9075 lon: 116.39723 facility: Gansu Provincial Maternal and Child Health Care Hospital city: Lanzhou state: Gansu zip: 730050 country: China name: Weikai Wang, M.D. role: CONTACT phone: 0931-5188650 email: 35487284@qq.com lat: 36.05701 lon: 103.83987 facility: The Second School of Clinical Medicine, Southern Medical University city: Guangzhou state: Guangdong country: China name: Yuxiong Guo, M.D. role: CONTACT phone: 13423661583 email: 2003kellylaw@163.com lat: 23.11667 lon: 113.25 facility: The People's Hospital of Guangxi Zhuang Autonomous Region city: Nanning state: Guangxi country: China name: Hanwu Huang, M.D. role: CONTACT phone: 15107710327 email: 2503133021@qq.com lat: 22.81667 lon: 108.31667 facility: Henan Children's Hospital city: Zhengzhou state: Henan zip: 450014 country: China name: Feng Wang, M.D. role: CONTACT phone: 0371-85515892 email: wang.f365@163.com lat: 34.75778 lon: 113.64861 facility: Henan Provincial People's Hospital city: Zhengzhou state: Henan zip: 463599 country: China lat: 34.75778 lon: 113.64861 facility: Xi'an Children's Hospital city: Xi'an state: Shaanxi zip: 710002 country: China name: Yi Wang, M.D. role: CONTACT phone: 18591953652 email: wangyichengxian@163.com lat: 34.25833 lon: 108.92861 hasResults: False