For decades, techniques for extracorporeal lung support, such as extracorporeal membrane oxygenation (ECMO), have offered in specialized centres the possibility to completely or partly substitute lung function, thus, facilitating healing. Initially the application of ECMO was associated with severe complications, but significant technical progress in recent years has led to the development of safer systems and promotes a wider distribution of the technique. Supported by recent, positive study data, ECMO has become a promising option for acute respiratory distress syndrome (ARDS) therapy in specialized centers. Further developments and modifications, such as pumpless devices for extracorporeal lung support have the potential of becoming an interesting option for intensive care medicine - however, data of prospective studies showing efficacy are still not available.