This study compares complications in COVID-19 and non-COVID-19 patients with acute respiratory distress syndrome (ARDS) undergoing veno-venous extracorporeal membrane oxygenation (vv-ECMO). Retrospective analysis of 64 patients from March 2020 to March 2022 revealed higher pre-cannulation pneumothorax rates in COVID-19 patients. However, post-cannulation complications and clinical outcomes were similar between groups. Non-survivors showed a trend towards higher post-vv-ECMO complications.