A pilot randomised controlled study examined a low-frequency ventilation strategy in patients with ARDS receiving extracorporeal membrane oxygenation. The intervention used very low respiratory rates and tidal volumes with controlled levels of PEEP and plateau pressure during the first 72 hours of ECMO. The trial was small, with 44 patients, so it was not designed to establish definitive mortality benefit. Its importance is mechanistic and practical: ECMO can take over much of the work of gas exchange, allowing clinicians to reduce ventilator intensity and potentially limit further ventilator-induced lung injury. The study fits CritiCARE's discussions of VV-ECMO, refractory hypoxaemia, ventilation strategy during ECMO and weaning or decannulation. For HCPs, the lesson is that ECMO should not simply be added on top of conventional ventilation settings. Once extracorporeal support is established, the ventilator strategy should be reconsidered to minimise mechanical stress while preserving lung recruitment and patient synchrony. The paper also highlights the limits of current evidence. A physiologically attractive strategy still requires larger trials before being adopted as a universal ECMO protocol. The practical framework remains: protect the lung, monitor gas exchange and haemodynamics, and progressively reassess how much ventilatory support the recovering patient truly needs.