AbstractThe indication and usage for Extracorporeal Life Support (ECLS) has increased significantly over the last 10years, and more and more hospitals are now offering this service. Despite this trend, ECLS is a mature “daily business” in only a few centers.In this context, the importance of simulation in the field of ECLS must be strongly emphasized for the following reasons:•Infrequent use of the technology requires practicing of routine actions on ECLS, as necessary preparation for the moment that it will be actually used,•Emergencies on ECLS are fortunately even rarer than its practice, but are potentially fatal and call for repetitive and frequent training targeting at identifying, interacting and solving these problems.