Acute respiratory distress syndrome (ARDS) is a permeability pulmonary edema due to lung injury from various causes. In 2012, a new definition, taking into account the degree of hypoxemia and the level of positive end-expiratory pressure (PEEP), was published. In addition to progress in the support of organ failures in intensive care, mortality in patients suffering from ARDS has decreased significantly. This improved prognosis is also due to the advent of protective mechanical ventilation that has limited ventilator-induced lung injury (VILI). The treatment of ARDS consists on causative treatment and a strategy of protective ventilation associated with a PEEP level between 10 and 15 cm H20 and the use of prone position or inhaled nitric oxide in the severest cases. The role of extracorporeal membrane oxygenation as adjuvant therapy in ARDS remains unclear.