Mechanical ventilation remains the signature tool of critical care; however, within the past decade, a growing body of evidence suggests that positive pressure ventilation in acute respiratory failure is a double-edged sword that is associated with life-threatening complications such as nosocomial pneumonia and low cardiac performance. Essentially, solutions are required to provide adequate gas exchange and stable acid-base status while optimizing and maximizing pulmonary as well as remote organ protection. Recently, the first commercially available extracorporeal membrane ventilator was approved for clinical lung support, the Interventional Lung Assist. This article gives an overview of the potential indications for this device and the current clinical evidence in extracorporeal ventilation.