ECMO and V-A ECLS might be considered a therapeutic option in patients with severe ARDS and/or with cardiac failure or cardiac arrest. In our experience, a well-timed start of ECMO in case of ARDS, prevents the progression of ventilator-induced lung injury and increases the chances of lung recovery. Also in case of cardiogenic shock, an extracorporeal technique seems a viable option and increases the possibility of early cardiac recovery avoiding neurological damages and multi-organ failure.