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BACKGROUND Veno-venous extracorporeal membrane layer oxygenation (VV-ECMO) is increasingly used for intense respiratory distress syndrome (ARDS) and also as a bridge to lung transplantation. After initiation of VV-ECMO, systemic anticoagulation is typically administered, that may trigger hemorrhaging diathesis. Here, we investigated whether VV-ECMO may be administered without continuous systemic anticoagulation for customers with ARDS. TECHNIQUES This is a retrospective report on