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ECMO can either provide total cardiopulmonary support (veno-arterial or VA-ECMO) or pulmonary support (veno-venous or VV-ECMO). The technique effectively enables the use of CPB in an ICU setting. In adult practice, ECMO was initially reserved for patients with severe respiratory failure secondary to ARDS. ECMO in adults fell out of favour, largely because of poor outcomes. In paediatric practice, where outcomes are generally better, ECMO has remained in routine use for over three decades. Recent H1N1 (‘swine flu’) epidemics have led to a re-examination of the role of ECMO in adults with respiratory failure and a re-emergence of VV-ECMO.