Fig. 1

A typical serial chest radiographs of awake ECMO patients (Patient 10). a: On ICU admission day. This is the initial chest radiograph after intubation. Increased bilateral opacity in both lungs are noted. b: The second day after ICU admission. ECMO insertion was done due to refractory hypoxemia. Chest x-ray shows progressive increase of right opacity and newly left pneumothorax. The left pneumothorax was improved with chest tube and lower mechanical ventilation support level due to ECMO. c: On ECMO 5 days. There is improved pulmonary infiltration and pneumothorax, the patient was extubated and underwent awake ECMO to avoid ventilator-associated pneumonia. d: On ECMO 30 days. The patient was weaned from ECMO after this chest x-ray. e: Fourteen days after weaning from ECMO and discharge. f: one month after discharge