Extracorporeal life support (ECLS) (including extracorporeal membrane oxygenation [ECMO] and extracorporeal CO2 removal) can be used in patients with inadequate oxygen delivery, including ineffective oxygenation due to severe lung disease. The current 2009 influenza A(H1N1) [A(H1N1)] epidemic has promoted ECMO use2 due to the severe hypoxemia witnessed in several populations.2-7 Although not formally recommended, ECMO has been included among the “salvage therapies” listed on an important Web site (http://www.thoracic.org/clinical/critical-care/salvage-therapies-h1n1/pages/ecmo.php). There are conflicting results regarding efficacy of ECMO in hypoxemic lung failure in adults8-10 with commentaries reflecting different interpretations of the clinical trials.11-14 Support with ECMO is hazardous5 and more costly than mechanical ventilation support.9 Risks include bleeding, activation of complement, and the threats of air embolism, vascular damage, and infection. Thus, ECMO treatment of hypoxemic lung failure demands critical evaluation. We focus herein on the following question: Is ECLS useful in critically ill adults with ARDS following novel A(H1N1) influenza infection?