Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been used as a rescue therapy for patients with refractory coronavirus disease (COVID-19)–associated severe acute respiratory distress syndrome (ARDS) with survival rates similar to those reported for ECMO support of ARDS of other causes (1, 2). However, the need for prolonged ventilation, sedation, and immobility may limit long-term benefits of ECMO in these patients. Specifically, they are exposed to a high risk of ventilator-associated pneumonia (3). According to a recent case series, single-access, dual-stage VV-ECMO with extubation on ECMO (median time to extubation: 13 d) appeared to be safe and associated with a favorable prognosis for patients with severe COVID-19–associated ARDS (4). VV-ECMO has anecdotally been applied as an alternative to invasive mechanical ventilation (MV) in awake, spontaneously breathing patients with ARDS caused by Pneumocystis pneumonia (5) or immunocompromised status