IntroductionAs medical technology continues to advance, the options for treating what were once thought to be fatal conditions continue to increase. Extracorporeal membrane oxygenation (ECMO) has been used since the 1970s and has become a common therapy for infants with respiratory failure (Rehder, Turner, & Cheifetz, 2011). Despite the proven pediatric use of ECMO, ethical concerns about this therapy remain. There are concerns about the cost of this particular therapy in relation to outcomes (Richards & Joubert, 2013). There are also multiple complications that can occur during ECMO use and recently the expansion of ECMO use in adults with acute respiratory distress syndrome (ARDS), the use of ECMO as a bridging therapy while awaiting Organ transplantation and even the use of ECMO to maintain organ perfusion in organ donation have all raised ethical considerations. Research is ongoing to further explore these issues. ECMO Basics ECMO is an external cardiopulmonary bypass circuit that serves to temporarily replace the functions of the heart and lungs. This requires surgical placement of a catheter in a central vein located near the heart and a second catheter that can be placed in a different central vein (VV ECMO), used for respiratory support, or inserted into the artery (VA ECMO) , used when the patient requires cardiac and respiratory support. These catheters are connected to the ECMO machine where blood is pumped through an oxygenator where carbon dioxide is removed and oxygen instilled (http://nyp.org/services/carf/what-is-ecmo.html). ECMO has a established history of use as a pediatric modality with critically ill patients as a last-ditch life-saving effort. Yet, there is still controversy... middle of paper... adult Respiratory failure: life support in the new era. Intensive Care Med, 38, 210-220. http://dx.doi.org/10.1007/s00134-011-2439-2Mishra, V., Svennevig, J.L., Bugge, J.F., Andresen, S., Mathisen, A., Karlsen, H., ... Hagen , TP (2009, August 21, 2009). Cost of extracorporeal membrane oxygenation: evidence from Rikshospitalet University Hospital, Oslo, Norway. European Journal of Cardiothoracic Surgery, 37, 339-342. http://dx.doi.org/10.1016/j.ejcts.2009.06.059Rehder, K. J., Turner, D. A., & Cheifetz, I. M. (2011). Use of extracorporeal life support in adults with severe acute respiratory failure. Expert Rev. Respir. Med., 5(5), 627-633. http://dx.doi.org/10.1586/ERS.11.57Richards, G. A., & Joubert, I. (2013, July 2013). Extracorporeal membrane oxygenation (ECMO). South African Journal of Intensive Care, 29(1), 7-9. http://dx.doi.org/10.7196/SAJCC.161