Few treatment modalities for the critically ill have experienced a roller coaster ride like the use of extracorporeal membrane oxygenation (ECMO). At various times, ECMO has been hailed as “life saving”; at other times, its widespread use has been seriously questioned, primarily because of the invasiveness of the technique, the potential (and very real) complications involved, the lack of a randomized trial demonstrating unequivocal efficacy, and the improving care of the critically ill patient that has increased survival even without the use of such a procedure. Originally proposed and investigated as a treatment for ARDS in the adult patient,1 ECMO rapidly became the treatment of choice for newborns with respiratory failure unresponsive to conventional ventilator management. ECMO “centers” proliferated throughout the United States, and then later worldwide, and thousands of newborns were treated with the technique. It seemed no newborn ICU was complete without an ECMO apparatus of its own. There is no doubt that many newborns are alive today because of ECMO, but it is also probably equally true that many were treated with ECMO who could have survived very well without it.