To report our experience with extracorporeal membrane oxygenation (ECMO) in a congenital heart surgery program. Since 12/1996, 24 patients (8 newborns, 9 infants, 3 children, 4 adolescents/ adults 17–23 years), mean age 4.0±7.4 years (2 days–23 years), body weight 2.7–87 kg had ECMO as circulatory support. Indication was failure to wean from cardiopulmonary bypass in the majority of cases. Mean duration of support was 3.8±2.9 d (12 h–13 d). Fourteen patients were weaned from ECMO (9 discharged), three successfully transplanted (one after switching to a pulsatile assist device). One patient on left-ventricular support required ECMO for sudden rightventricular failure (decreased). There were six deaths on ECMO due to multiorgan failure (MOV) (3) or no myocardial recovery (3). Six patients died after weaning (3 MOV, 2 myocardial failure, 1 fungal sepsis). Overall, twelve patients (50%) were discharged and are clinically well after 3.4±2.4 years (0.8–7.2 years). In our series, ECMO markedly reduces mortality in patients who would otherwise not survive either open heart surgery or myocardial failure of any origin and was not associated with discernible morbidity in the midterm.