Over the years, there have been many innovations that have come and gone. It is not often that a single idea dramatically changes how critical care is delivered. Since the era of the Vietnam War, Intensivists have been dealing with acute respiratory distress syndrome (formally known as Da Nang lung, adult respiratory distress, and others) and cardiogenic shock, but with recent developments in extracorporeal membrane oxygenation (ECMO), ECMO is able to sustain life to give these critically ill patients an opportunity to heal. Just as importantly, systems had to evolve to facilitate transfer of critically ill patients, equipment had to be developed to fly heart-lung equipment between facilities, protocols for transport had to be created, and (gasp) pulmonologists had to cooperate with cardiothoracic surgeons. ECMO support has required hospitals to either commit tremendous resources to establish ECMO programs or align with ECMO centers to refer these patients to hospitals that do have ECMO support. Over the past decade, ECMO programs grew at different rates, with different components, and with different styles. This issue of Critical Care Clinics had contributors from multiple ECMO sites to help share ideas that have proven successful. The editors would like to thank all the contributors for their time to compose this issue and for their dedication to ECMO services.