The field of extracorporeal support is moving forward rapidly. New technology, improved experience with a variety of patients, and successful outcomes in groups previously excluded from extracorporeal life support are increasing the use of this technique in patient support. Although initial reports of outcome are encouraging, they are often taken from single-center reports or large databases without specific detail to answer many of the relevant questions or for eras that do not reflect the effects of new technology. Collaboration between investigators, rigorous scientific data collection and analysis, and careful short- and long-term outcomes for patients receiving extracorporeal life support are imperative to avoid improper use of this high-resource, high-cost technology and to establish the efficacy of new devices and techniques. Bleeding and thrombosis remain devastating complications and efforts to reduce complications and improve anticoagulation regimens or eliminate the need for anticoagulation would be of major benefit to the field.