The pediatric population comprises 38% of hospital admissions for burns in the United States. In the age group of 1- to 14-year-olds, a 62% total body surface area burn represents the median lethal dose and carries a lower mortality rate for burn size than in infants or adults. Adult respiratory distress syndrome (ARDS) is a common accompaniment to severe burn injury. Mortality rates of 50% to 80% are expected once ARDS occurs. This is a report of an 11-month-old boy who had fulminant ARDS after a 32% total body surface area second degree burn. After conventional therapy with maximum mechanical ventilatory support failed, salvage therapy with extracorporeal membrane oxygenation (ECMO) was instituted. ECMO was successfully terminated after 28 days. Open lung biopsy specimens obtained before instituting ECMO and on ECMO day 26 exhibited severe but histologically reversible lung disease and improved alveolar aeration as a result of treatment. This is the first reported survival of a pediatric patient with thermal injury and ARDS by using ECMO for the treatment of respiratory failure.