periods. Having accepted all the potential risks of ECMO, it would be optimal to use the circuit to provide the maximum amount of oxygen that is possible. This means using a membrane lung with a high rated flow and an optimal range of hemoglobin resulting in the highest possible oxygen content leaving the membrane lung. While awaiting ongoing RCTs of transfusion thresholds in ECMO patients (eg, Trial of Indication-based Transfusion of Red blood cells in ECMO [TITRE] NCT05405426; www.ecmotitretrial.org), ELSO recommends that selected ECMO patients may warrant transfusion of pRBC to above those levels generally accepted in critically ill patients. Currently, there is no scientific evidence that commonly accepted transfusion trigger policies apply to ECMO patients.