Traditional venovenous (VV) extracorporeal membrane oxygenation (ECMO) for respiratory failure requires deep sedation and immobilization of patients, both of which carry high morbidity and mortality rates. Technological innovation has now enabled ambulation while supporting patients on ECMO, reducing the complications associated with conventional treatment. In fact, ambulatory VV ECMO is a paradigm change, challenging the current standards for management of patients with acute respiratory distress syndrome (ARDS). Several advancements have contributed to improvements in device design and ECMO components, including dual-lumen cannulas, modern polymethypentene oxygenators, and centrifugal pumps that are crucial for ambulatory ECMO. Pediatric and cardiac ECMO is not within the scope of our discussion.