Our aim was to describe the technique and results of using inhaled prostacyclin (iPGI2) to enable the safe interhospital helicopter transport of a patient with ARDS complicated by life-threatening hypoxemia. The case describes a 32-year-old women with ARDS complicated by life-threatening hypoxemia who was referred to our ARDS referral center for further management. Multiple attempts to place the patient on the transport ventilator failed because of severe hypoxemia. After the administration of iPGI2, oxygen saturation improved significantly, enabling the transport to occur safely by medevac helicopter. iPGI2 is a valuable adjunct for the medical transport team to enable the safe transport of critically ill patients with severe hypoxemia. The simple, lightweight, and portable delivery system makes it ideal for use during all forms of aeromedical transport.