As demonstrated in the first book, the management of patients with profound respiratory failure or cardiogenic shock has evolved significantly over the years with advances in diagnostic and therapeutic options. While the mortality for these often-overlapping problems remains high, progress in the multi-disciplinary approach to these complex clinical problems has improved survival substantially. The focus of this second book is to explore some of the advanced topics and current literature regarding the management of patients requiring extra-corporeal membrane oxygenation (ECMO). As illustrated in the spectrum of topics discussed, ECMO is not only a complex therapy in itself, but the challenges, problems, and complications that arise in this unique area of medicine require engagement by many diverse disciplines. While there are many physiological issues such as organ protection, management of circuit complications, and optimal lung and cardiac protection for recovery, the use of ECMO also introduces a variety of legal and ethical challenges, particularly end-of-life issues (including brain death) in patients for whom recovery, despite extra-corporeal support, is most likely futile. Each of the chapters, written by world-renowned experts in the field, highlights a different important aspect in understanding the complex dynamics of extra-corporeal support and its impact on human pathophysiology. While many of the topics discussed involve sophisticated concepts, each chapter was written with the goal of providing a comprehensive review suitable for any level of training and experience. Many of the topic discussed highlight the state-of-the-art literature along with expert experiences and perspectives as we try to learn more about the overlapping art and science of a field of medicine that has only recently been accepted as a mainstream treatment option. Students of ECMO, ranging from early stage healthcare providers to master physicians, will benefit from the insights presented.