The first randomized clinical trials failed to demonstrate beneficial effect of ECMO for severe respiratory failure in the 1970s and 1980s. Since then, technical improvements for ECMO on one hand, and better treatment of the ARDS (protective ventilation and others) on the other hand, have renewed interest in ECMO [12] . The recent CESAR trial (Conventional Ventilation or ECMO for Severer Adult Respiratory Failure [13] ) demonstrated a possible beneficial effect of ECMO. Of those patients referred for ECMO, there was 63% survival rate at six months without disability, compared to 47% in those who were assigned to conventional management. This translates to one extra survivor without disability for every six patients treated.