Extracorporeal membrane oxygenation (ECMO) is a general term that describes the short- or long-term support of the heart and/or lungs in neonates, children and adults. It offers a treatment option for severe cardiac and/or respiratory failure from neonate to adult. Used as venoarterial extracorporeal membrane oxygenation (VA-ECMO), it remains the most commonly used modality for short- to mid-term mechanical support of the failing circulation in children. The aim of this article is to review the clinical indications, different circuits, technical options, patient management, and potential risks and benefits of this therapy for children. As ECMO therapy is an overwhelming event for the whole family we also highlight the role of psychosocial counselling and support for the parents.