**2. Udine experience**

Out of 410 Htx performed at the University Hospital of Udine since 2005, a total of 41 (10%) patients were directly bridged to HTx with ECMO. The ECMO circuit consisted of a centrifugal blood pump (Rotaflow, Maquet, Hirrlingen, Germany) with a hollow fiber oxygenator (Quadrox). Tubes (33 mL of priming), as well as the oxygenator and the pump, were coated with bioline (maquet), which combines polypeptides and heparin.

Clinical characteristics of the population at the time of HTx are shown in **Table 1**. In brief, the median age was 57 years (range 38–73 years), and 80% (n = 33) were male patients. The median creatinine level was 1.6 mg/dl (range 0.8–3.5 mg/dl), and the rate of renal replacement treatment was 15% (n = 6). 25 patients (61%) were mechanically

#### *Extracorporeal Membrane Oxygenation Support Therapy*


#### **Table 1.**

*Baseline clinical characteristics of patients bridged to HTx with ECMO support.*

#### **Figure 2.**

*Survival at 30 days and at 1 year of the overall population (total), APACHE IV score < 47 population (low-risk) and APACHE IV score* ≥ *47 population (high-risk).*

ventilated, 32 (78%) had IABP, and 2 (5%) an impella support for LV unloading. The median duration of ECMO support was 10 days (range 3–21 days).

After HTx, 30 days mortality was 15% (n = 6), and 1 year survival was 71% (six patients died after a median time from HTx of 73 days, range 42–237 days).

Since our previous experience revealed very poor outcomes for patients with values of APACHE IV score ≥ 47 [], we further extensively adopted this tool to stratify patients into two groups: low-risk (if APACHE IV score value was <47) and high-risk (APACHE IV score ≥ 47).

The low-risk group (n = 30) and the high-risk group (n = 11) had a median APACHE IV score of 34 (range 28–45) and 52 (47–60), respectively (p < 0.001).

As shown in the **Figure 2**, compared to other patients, those having an APACHE IV score had a significantly lower 30 days survival (p < 0.001) and 1 year-survival (p < 0.001).
