The clinical tolerance of extracorporeal membrane oxygenation (ECMO) membrane changes in acute respiratory distress syndrome (ARDS) patients under veno-venous ECMO (VV-ECMO) has not been reported. The aim of this study was to describe the tolerance of membrane change. Patients requiring VV-ECMO were retrospectively included between March 2020 and May 2022. In case of membrane dysfunction or an increase in hemolysis markers or an alteration in gas exchange, a membrane change was performed. The primary outcome was a composite measure defined as the occurrence of at least one of the following events within 1 hour of membrane change: severe hypoxemia, hemodynamic collapse, bradycardia, arrhythmia, cardiac arrest, and death. During the study period, 70 patients required a VV-ECMO, 29 (41%) of whom died. Thirty-two patients required a membrane change for a total of 56 changes. The primary outcome occurred for 33 (59%) changes. Arterial desaturation <80% occurred for all complicated membrane changes and cardiac arrest concerned nine changes (16%). Low tidal volume (VT<\/sub>), respiratory system compliance (Crs), PaO2<\/sub>, and high ECMO blood flow (QECMO<\/sub>) were associated with poor tolerance of membrane change. Threshold values of 130\u2009ml for VT<\/sub>, 9.3\u2009cm H2<\/sub>O for Crs, 72\u2009mm Hg for PaO2<\/sub>, and 3.65\u2009L\/minute for QECMO<\/sub>\u00a0best determined the risk of poor tolerance of membrane change.<\/p>\n