Critical illness during pregnancy poses significant challenges driven by complex interactions between physiological changes, pre-existing conditions, and healthcare disparities. In high-income countries, increasing maternal age and comorbidities complicate obstetric care by triggering an unprecedented rise in cardiac disease during pregnancy, while infections like influenza and COVID-19 are important causes of maternal adult respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) gained prominence as a vital intervention, providing respiratory and/or cardiac support, for varying indications between antenatal and postpartum periods. The physiological changes of pregnancy demand close attention and adjustment of ECMO parameters, along with multidisciplinary collaboration. While potential complications such as bleeding and thromboembolism require vigilant management and optimal management of ECMO support in pregnancy still needs to be elucidated, ECMO nevertheless yields favorable maternal and fetal outcomes.