Extracorporeal membrane oxygenation (ECMO) is life-supporting in patients with cardiac or respiratory failure. In the operating room, ECMO is used to support high-risk cardiac, thoracic, and pediatric surgery by providing oxygenation and circulation while giving surgeons a safe margin of work. Some recent developments are portable ECMO devices, better cannulation, and integration into critical care pathways. ECMO has maximized the number of possible surgeries in critically ill patients by offering temporary assistance that provides a transition towards recovery or transplant. Safe and effective use of ECMO is ensured by multidisciplinary training, maximizing patient outcomes in high-risk surgical settings.