In this Classic Papers feature, we highlight Dr. Robert H. Bartlett's ground-breaking case series from 1977 reporting 28 pediatric and adult patients supported by extracorporeal membrane oxygenation (ECMO). Dr. P. Peal O'Rourke, who conducted early, innovative clinical research on ECMO, provides her perspective on the state of critical care for children in the late 1970s, how this paper and Dr. Bartlett himself influenced it, and difficulties faced in developing ECMO programs in the 1980s. Dr. Bartlett offers answers to questions about how his work on ECMO began, the reaction of the critical care community to the use of ECMO, and how challenges in studying ECMO in clinical trials have been approached.