Background: The use of venovenous extra corporeal membrane oxygenation (VV-Ecmo) in severe hypoxemic respiratory failure from coronavirus disease 2019 has been described but reported utilization and outcomes are variable and detailed data on patient characteristics is lacking. Objective: Our study aimed to evaluate the effect of extra-corporeal membrane oxygenation (ECMO) when compared to the traditional conventional protective lung strategy mechanical ventilation for Covid-19 ARDS associated Respiratory failure. Patients and methods: This is a prospective study with 1:1 randomization for either to go through ECMO or keep on conventional mechanical ventilation with protective lung strategy for patient Covid-ARDS associated with respiratory failure. One hundred patients were randomized in each group. Results: Hundred patients were in each group. Age was 48.4 ± 9.0 in the standard care mechanical ventilation group versus 47.8 ± 8.3 in the ECMO group, 54 males and 46 females in the standard care group and 59 males and 41 females in the ECMO group. Vasopressor weaning was in 40 cases in the standard care group and 64 patients in the ECMO group with a significant statistical difference in favor of the ECMO group (p-value < 0.001). Also, weaning from mechanical ventilation was 29 patients versus 66 patients in the standard care group and in the ECMO group respectively (P-value <0.001). Also the inflammatory markers like CRP, D-dimer, procalcitonin, IL-6 and ferritin were more improved in the ECMO group, more than in the standard care group with a significant statistical difference (p-value <0.001), Conclusion: ECMO in Covid-19 ARDS respiratory failure patients was associated with weaning from mechanical ventilation & vasopressors and more improvement in the markers profile, together with the radiological point of view and arterial blood gases parameters when compared to the standard care group together with a great reduction in the length of stay in the intensive care unit with decrease in the mortality.