There is a growing trend in the use of small, portable extracorporeal membrane oxygenation (ECMO) systems for hemodynamic support. In years past, ECMO systems were a tool of the operating room, primarily for bypass surgery. Older systems required a perfusionist to watch the machine 24 hours a day while it was in operation. Today’s ECMOs use consoles that are much easier to use and do not require a full-time person to monitor. Also, as the technology has been miniaturized, simplified and now uses a percutaneous access system, ECMOs are being used outside the OR, including the cath lab, when a large amount of support is needed that cannot be provided by IABPs or pVADs.