Introduction: Extracorporeal membrane oxygenation (ECMO) is considered a rescue therapy in severe cases of acute cardiac and or respiratory failure. Aim of the work: We describe our initial experience at the first ECMO center in Egypt. Methods: Our adult ECMO program started in January 2014. Since then we supported eleven respiratory failure patients on ECMO indicated according to ELSO guidelines and one case of ECMO CPR. Respiratory failure patients were subjected to VV ECMO when lung injury score (LIS) was above 3 and PaO2/FiO2