Extracorporeal membrane oxygenation (ECMO) is providing an increasingly important therapy for patients in severe heart and lung failure. Care of these patients is complex, with changes in circulation that mean standard advanced life support algorithms may not always be applicable. Through collaboration between all UK ECMO centres and eight national societies, we have assessed the current evidence base and, using a modified Delphi process, produced national guidelines on the management of emergencies on ECMO. The guidelines focus on the recognition of cardiac arrest, team prioritisation, and early ECMO troubleshooting for key life-saving interventions. The guidelines are applicable to all staff and types of ECMO performed in the UK and should be utilised in conjunction with appropriate training. In summary, the joint British societies and ECMO centres working group present the UK guideline for the management of emergencies in ECMO.