Extracorporeal membrane oxygenation (ECMO) was derived from the conventional cardiopulmonary bypass during the cardiac procedure. The tool had changed the concept of the cardiac surgery, but its application was limited due to high incidence of complication rate when prolonged used. The initial indication of ECMO was focused on the neonatal lung disease, that was not generally accepted in Taiwan. We tried to apply the device since 1994 that was firstly applied in a victim under cardiopulmonary resuscitation for two hours. It certainly suffered from the poor result. We simply followed the suggestion from the past recommendation of ECMO, and ECMO had been repeatedly proved its efficacy in rescuing the critical clinical condition.
　　We started to organize a team in working this protocol to improve the possible encouraging prosperous modality. Several application had been tried including myocarditis, post-cardiotomy shock, septic shock, respiratory failure, and even in the dying process – cardiopulmonary resuscitation. We tried every effort to break certain limitation and changed the several procedures that was considered standard regulation. We also broke the concept of the ECMO contraindication in CPR in 1990. The term of ECPR (extracorporeal cardiopulmonary resuscitation) had been re-defined since our several publications in this field. The guideline of resuscitation, not only in America but also in Europe, had been widely recommended as a therapeutic option if affordable. Since then, the followers had changed its roe to the game-changer.
　　Nowadays, ECMO is not applied on the cardiovascular field, and it is widely accepted in different territories, such intensive care, respiratory failure, and even in the immunotherapy with cytokine storm. The more understanding the circulatory support, and the more advance in the different thinking can be explored in the future.