ECMO is a reliable and useful treatment for patient with acute cardiac failure. However, outcomes of cardiac ECMO are not yet as successful as case of ECMO support for respiratory failure. To improve the results of cardiac ECMO, proper patient selection, management, and weaning strategy are crucial. Other options, including LVADs and heart transplant, should be considered when patients do not show any improvements under ECMO therapy. A multidisciplinary approach is required to provide the maximum chance of survival after ECMO treatment.