Extracorporeal membrane oxygenation (ECMO) is very quickly becoming a mainstream therapy for patients experiencing acute, severe, and often medically refractory cardiopulmonary failure. Over the years, the technology has improved and the guidelines, protocols, and indications for therapy have been refined. Similar to other "resource-intensive" technologies in which success or failure is often seen and experienced in the setting of a brief hospitalization, there is often much interest and intrigue when a patient is supported on ECMO. Success requires a team effort and a tremendous amount of hard work and effective communication. The hope is that this text will serve as a cornerstone for program growth and development as well as an inspiration for those intrigued by the potential benefits of ECMO.