Does extracorporeal membrane oxygenation (ECMO) improve outcomes in patients with severe adult respiratory failure? The CESAR trial compared the efficacy and cost-effectiveness of ECMO vs. conventional ventilatory support in patients with severe adult respiratory failure. A total of 180 patients were randomized to receive either conventional care or ECMO. The trial found that ECMO was associated with a significant reduction in 6-month survival without major disability. However, the study also highlighted the substantiavl costs associated with ECMO, which raises important considerations for resource allocation in critical care. The trial established ECMO as a viable option for patients with severe, refractory respiratory failure.