Abstract
Legionella pneumophila can cause acute respiratory distress syndrome (ARDS), which often requires intense ventilatory management. L. pneumophila is an aerobic bacterium that prefers a high-oxygen environment. However, existing treatment strategies, including veno-venous extracorporeal membrane oxygenation (V-V ECMO), have not considered the pathogen's preference for high-oxygen environments. Herein, we report two cases of patients with severe legionella pneumonia treated with V-V ECMO. The treatment strategy in these two cases was to maintain the lowest possible oxygen concentrations to inhibit the activity of L. pneumophila. This strategy was successful, indicating that V-V ECMO may be useful to improve outcomes in severe ARDS caused by L. pneumophila, especially when introduced earlier.