Between 1984 and 1988, 89 infants and children with severe respiratory failure were supported by extracorporeal membrane oxygenation. Major clinical diagnoses included congenital diaphragmatic hernias (34), meconium aspiration syndrome (26), and sepsis (8). Extracorporeal membrane oxygenation was used for patients with a predicted mortality rate of at least 80% based on an oxygenation index greater than 0.4. Venoarterial bypass was accomplished by way of right cervical cannulation of the common carotid artery and internal jugular vein. Overall survival was 71% but varied widely by diagnosis and progressively improved over time. The average extracorporeal membrane oxygenation run was 5.7 days. Intracranial hemorrhage was the most serious complication occurring in 16% of patients. Mechanical circuit complications were seen in 22% but rarely related to significant morbidity. Extracorporeal membrane oxygenation appears to provide effective cardiopulmonary support for selected pediatric respiratory problems. It affords those with potentially reversible pathophysiology the temporal opportunity for successful medical or surgical therapies.