Background: In February 2021, Mayotte Island experienced a dramatic second wave of Sars Cov 2 outbreak. This situation caused a saturation of the critical care unit with intubated patient suffering from Sars Cov 2 acute respiratory distress syndrome (ARDS). Despite the increase of 150 % of the critical unit capacity, aeromedical evacuation to the Reunion Island were mandatory. During February 2021, 115 patients were hospitalized in intensive care unit for Sars Cov 2 and required mechanical ventilation. Of these 115 patients, 67 were transferred to Reunion Island. Method: We lead a prospective cohort study to compare the 28 days outcome between evacuated and non-evacuated patient. We recorded the adverse events which happened during the transfer. We studied the evolution of the SpO2/FiO2 ratio, one hour (H-1) before the transportation, during the flight and twenty-four hour (H+24) after the arrival in the critical care unit in the Reunion Island. Results: There was no difference in 28 days mortality between non-evacuated and evacuated patients (35% vs 28 %, p=0.42). We found a higher proportion of mechanical ventilation acquired pneumonia (VAP) in evacuated patients (48% vs 67%, p = 0.012). We registered 46 adverse events during the flight. No major adverse event was recorded. We also found a statical alteration of the SpO2/FiO2 ratio evolution from H-1 to H+24 (240 vs 196 , p< 0.0001). Conclusion: This cohort confirm the safety of aeromedical evacuation of intubated patient suffering from ARDS. Hospitalization in intensive care unit is affected by more VAP. No mortality excess is found. We propose an operational tool for the triage. Larger studies are needed to confirm his implementation at a larger scale.