The outcome of patients with coronavirus disease (COVID-19) treated in ICUs is unsatisfying (1). Venovenous extracorporeal membrane oxygenation (vvECMO) can serve as a rescue strategy when patients deteriorate during invasive ventilation (2, 3). Using 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 (7). Reports on awake-ECMO for COVID-19 are currently limited to case reports