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Extracorporeal membrane oxygenation (ECMO) is an advanced modality of life support for neonatal, paediatric and adult patients with cardiopulmonary compromise resistant to conventional critical care management. This issue of SAJCC features a position statement proposing guidelines for the use of ECMO in South Africa, where unique clinical scenarios are often presented for critical care management. ECMO should be available for selected cases in advanced healthcare systems, and it should be performed in centres that have done the necessary planning, preparation and training.