The outcome of COVID-19 patients treated on intensive care units (ICU) is unsatisfying (1). Veno-venous extracorporeal membrane oxygenation (vv-ECMO) can serve as a rescue strategy when patients deteriorate during invasive ventilation (2, 3).

Utilizing extracorporeal membrane oxygenation (ECMO) in awake patients without endotracheal intubation (awake-ECMO) has shown satisfying results in immunocompromised patients or as a bridge-to-transplant strategy (4-6), but bears ECMO-specific risks such as bleeding and – specifically in awake patients – self inflicted lung injury.

Reports on awake-ECMO for COVID-19 are currently limited to case reports