There are quarter of a million articles in PubMed since the wake of the COVID-19 pandemic with about fifteen hundred articles on extracorporeal membrane oxygenation (ECMO) alone. Those that are entrenched in the field of ECMO and Mechanical Circulatory Support have been privileged to use these lifesaving technologies in a select few patients albeit the percentage of patients saved is miniscule compared with the sheer enormity of deaths sustained in the pandemic.¹ Since the pandemic, we have all had the privilege to advance this technology in the setting of advanced respiratory failure unlike any other time since the birth of the cardiopulmonary bypass pump by John Gibbon in 1953² and subsequent perfection of ECMO technology over decades by Bartlett et al.^3,4 Several guidelines have since been published about rescuing patients with refractory respiratory failure and cardiogenic shock in the setting of COVID-19.^5–7 The pandemic has also placed a significant strain on resources on the critical care teams. Using a systematic approach in caring for these patients including the ability to transport ECMO patients to hub hospital from community hospitals that ensures not just the safety of the patients but that of the personnel is crucial to the success of those programs. To really understand the significance of risk involved in caring for these COVID-19 patients, we need to recognize the countless lives lost in the early months of the pandemic where there was no reassurance of vaccines, adequate personal protective equipment (PPE), or grave recognition of inherent personal risk. According to a private site that tracks death of clinicians, there have been more than 3500 clinicians that have succumbed to the pandemic as they rendered care by April 2021.⁸ There remained answered questions if providing such care posed an inherent risk to the critical care transport team. Additionally, when crew members are COVID-19 positive with breakthrough infections, it poses a significant threat to the hospital systems in their ability to deliver high caliber care efficiently.