Moreover, some investigators reported haptoglobin among potential genes differently expressed in patients with or without VAP.34 Interestingly, lower levels of transferrin before ECMO cannulation were independently associated with VAP onset, suggesting a potential role of the iron pathway involved in inflammatory and oxidative reactions in the onset of VAP.30,35 Our findings suggest that decreasing the hemolysis levels and modulating the iron pathway may contribute on preventing VAP onset in ECMO. This evidence concerns the gene HP and ventilator-associated pneumonia.