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Purpose: The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patientswith severe acute respiratory failure (ARF). Materials and Methods: From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. Results: Overall, 68% of patients survivedamong those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcomewith a 94% survival rate. Conclusion: VV ECMO is an excellent, life-savingtreatment option in patients suffering from acute and life-threatening respiratoryfailure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.