The immense increase of patients treated with extra corporeal membrane oxygenation (ECMO) in the last few years, along with the uncertainty of outcomes as well as the lack of clarity on the intended treatment direction, these situations which are considered by some to be just delaying of death and even worse than death. These circumstances create disagreements among surrogates, and between health care providers and surrogates, and emerge unique ethical challenges about the use of this new technology. In this article we discuss these challenging questions.