IntroductionExtracorporealmembraneoxygenation (ECMO)is amodifiedadaptationofconventional cardiopulmonary bypass techniques for prolonged cardiopulmonarysupport using intrathoracic or extrathoracic cannulation. ECMO is currently used atspecializedcenterstosupport patientsithrespiratoryorcardiacfailurehoareunresponsive to conventional therapeutic interventions. !Extracorporeal membrane oxygenation (ECMO) uses technology derived fromcardiopulmonary bypass (C"#) that allos gas exchange outside the body. $naddition% circulatory support can also be provided. &'lthough long recognized as a successful therapy in neonates%!%& ECMO haslately been used increasingly in adults as a rescue therapy for acute lung in(ury (')$)%acute respiratory distress syndrome ('*+,)% and severe acute respiratory failure.!-.$t has also been used in the treatment of acute cardiac failure due to cardiogenic shoc/(acute myocardial infarction% ischemic and nonischemic cardiomyopa- thy%myocarditis% pulmonary embolus% and cardiac arrest) and for postcardiotomysyndromes (failure to ean from cardiopulmonary bypass folloing cardiacsurgery).0ECMO is no also used in adults as a rescue therapy to bridge to heart% lung%or heart-lung trans- plant% as rescue therapy from primary graft dysfunction ("1+)after trans- plant% and to bridge patients ith acute cardiac failure to support ith aventricular assist device.02.1 HistoryEC), and the development of the heart-lung machine in cardiac surgery by+r.2ohn3. 1ibbon2r. sharedacommoninterovenhistoryandereprimarilyintended for pulmonary support. ECMO as introduced for the treatment of severeacuterespiratorydistresssyndrome('*+,)inthe!.45s. +r.6heodore7olobopioneeredtheperfectionof flopatterns inthe membrane lung% themethodoflayering silicone and the design of vascular access catheters. 6he concept of heparintitrationhelpedinreducingthebleedingcomplications% andtherefineddesignofcircuits ith elimination of stagnant flo areas and incorporation of bladder systemsredefinedECMO. +r.+onald3ill in!.4!reportedthesurvival ofa&8-year-oldpolytrauma patient ith ruptured aorta after a motorcycle accident% ho evenaccording to today9s standard ould not have been considered a good ECMOoutcome candidate% as successfully treated on ECMO during the acute phase of thedisease. $n the folloing fe years% not much success in ECMO outcome and overallsurvival asseenincomparisontoneerventilatorymanagementstrategies.6hishad put ECMO in the bac/yard of management options ith a failing repute. $n !.4&%clinical applicationof ECMOinrespiratoryfailureof neborns andadults asattempted. 6hereasrevival ofinterest onlyafter+r.*obert 3. #artlett in!.4:reported the first neonatal ECMO survivor% baby Esperanza. 6his as the baby of apoor% illiterate peasant oman from #a(a% Mexico. 6he mother as determined thather child ould have a better life as a ;nited ,tates citizen% crossed the border andheadedfor )os 'ngeles. Enrouteher membranerupturedandsheas ta/entoOrange County Medical Centre here her daughter as born. +uring delivery% thechild had aspirated a large quantity of meconium and developed chemicalpneumonitis. Even ith maximal ventilatory support% the baby as unable to sustainadequateoxygenation.