In this informative presentation, anesthesiologist and critical care specialist Jacob T Gutsche, MD, examines the origins and progress of the mobile ECMO program at Penn Medicine. In so doing, he describes the incidentals and particulars of the program, including the decision-making process involved for ECMO in the field versus on-site after transport, the risks of injury and recirculation and the indications for VV ECMO at Penn. In analyzing the day-to-day evolution of Penn’s mobile ECMO program, Dr. Gutsche reaches several discerning conclusions. Among these: that deviations from established criteria for inclusion/exclusion and procedural protocols should be avoided; that highly complex care should be centralized by region; that ARDS patients should be stabilized prior to transfer; and that management of VA ECMO requires careful monitoring and nuanced protocols.