We read with interest the article by Mang et al.¹ Indeed, oxygenator thrombosis remains a common reason for circuit exchange, the risk of which increases with the duration of extracorporeal membrane oxygenation (ECMO) support.² Coinciding with the pandemic’s unprecedented increase of ECMO disposable demand, judicious use of limited supply was warranted. While we applaud the authors for their clever approach, we would like to add words of caution regarding their strategy.