Even more radical might be finding a viable alternative to endotracheal intubation and mechanical ventilation, both common reasons why critically ill patients require sedation and analgesia in the ICU. Extracorporeal membrane oxygenation (ECMO) has become an area of increasing interest following its recent successful use for H1N1-associated ARDS [77]. By providing extracorpo- real gas exchange, ECMO may mitigate the need for any aggressive mechanical ventilation, and any associated se- dation and/or neuromuscular paralysis, in patients with respiratory failure. Indeed, a number of groups have used “awake” ECMO to facilitate rehabilitation and ambula- tion in critically ill patients awaiting lung transplantation [78–80]. As this technology continues to improve and miniaturize, it is conceivable that mechanical ventilation could eventually be replaced by ECMO, helping clini- cians to realize the awake, calm, cooperative, and mobile ICU patient.