* known or high suspicion of pre-existing heart failure, unstable angina * presence of severe shock with hemodynamic instability despite escalating vasopressors * severe, underlying pulmonary infection or severe pulmonary disease except for covid-19 (copd, pulmonary fibrosis, lung cancer, bacterial pneumonia, etc.) * diagnosis of pulmonary hemorrhage * pregnancy or lactation * other significant cause than ards to the respiratory failure * age less than 18 * age more than 80 * need for ecmo (extracorporeal membrane oxygenation) during the study * anticipated transfer to another hospital within 72 hours * known hypersensitivity to exogenous surfactant * current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes

* known or high suspicion of pre-existing heart failure, unstable angina * presence of severe shock with hemodynamic instability despite escalating vasopressors * severe, underlying pulmonary infection or severe pulmonary disease except for covid-19 (copd, pulmonary fibrosis, lung cancer, bacterial pneumonia, etc.) * diagnosis of pulmonary hemorrhage * pregnancy or lactation * other significant cause than ards to the respiratory failure * age less than 18 * age more than 80 * need for ecmo (extracorporeal membrane oxygenation) during the study * anticipated transfer to another hospital within 72 hours * known hypersensitivity to exogenous surfactant * current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes

- known or high suspicion of pre-existing heart failure, unstable angina - presence of severe shock with hemodynamic instability despite escalating vasopressors - severe, underlying pulmonary infection or severe pulmonary disease except for covid-19 (copd, pulmonary fibrosis, lung cancer, bacterial pneumonia, etc.) - diagnosis of pulmonary hemorrhage - pregnancy or lactation - other significant cause than ards to the respiratory failure - age less than 18 - age more than 80 - need for ecmo (extracorporeal membrane oxygenation) during the study - anticipated transfer to another hospital within 72 hours - known hypersensitivity to exogenous surfactant - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes

- known or high suspicion of pre-existing heart failure, unstable angina - presence of severe shock with hemodynamic instability despite escalating vasopressors - severe, underlying pulmonary infection or severe pulmonary disease except for covid-19 (copd, pulmonary fibrosis, lung cancer, bacterial pneumonia, etc.) - diagnosis of pulmonary hemorrhage - pregnancy or lactation - other significant cause than ards to the respiratory failure - age less than 18 - age more than 80 - need for ecmo (extracorporeal membrane oxygenation) during the study - anticipated transfer to another hospital within 72 hours - known hypersensitivity to exogenous surfactant - current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes