In the past decade, there has been a rapid increase in utilization of ECMO to support patients with cardiopulmonary failure. The management of patients requiring ECMO support, however, remains technically challenging requiring a thorough knowledge of cardiopulmonary and circuit physiology with an ability to rapidly respond to changes. We present an interactive case-based session to highlight physiologic challenges unique to the ECMO patient. Each case offers the opportunity for data interpretation and decision making with panelists providing insight and guidance. Attendees will leave with a broader understanding of the ECMO circuit and physiology.