Despite advances in medical technology, the mortality rate for severe acute respiratory distress syndrome (ARDS) remains high at around 40% [1]. In recent years, multiple studies, systematic reviews, and meta-analyses [[2], [3], [4], [5]], including the study in this issue of Heart, Lung and Circulation published by Wang and colleagues [4], have indicated that treatment with veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be associated with better outcomes in severe ARDS than conventional mechanical ventilation. Increasing evidence will likely lead to an increase in the use of VV-ECMO in the treatment of ARDS in the coming years.