Extracorporeal Life Support (ECLS), including extracorporeal membrane oxygenation (ECMO) and extracorporeal carbon dioxide removal (ECCO2R), is increasingly used in severe respiratory failure. However, the data supporting the use of ECLS are limited. This session will review the best available evidence regarding ECLS in the context of the acute respiratory distress syndrome, chronic obstructive pulmonary disease, and end-stage lung disease when ECLS is implemented as a bridge to transplantation. Emphasis will be placed on the anticipated results from the recently concluded EOLIA trial, the use of ECCO2R to minimize invasive mechanical ventilation, and how ultra-protective ventilation may be applied without ECLS.