**1. Introduction**

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a temporary, mechanical, circulatory, and respiratory support system. Its main use is in patients with heart and/or respiratory failure, allowing complete support by ensuring continuous systemic perfusion and oxygenation.

This support system has traditionally been used as "rescue" therapy in patients with cardiogenic shock. However, ECMO implantation in emergency conditions is burdened by relevant mortality and morbidity, due to high vascular complications and reduced coronary reserve of patients with severe aortic stenosis or complex coronary artery disease, especially in the presence of a reduction of the global systolic function. In these cases, prolonged hypotension can lead to a rapid deterioration of hemodynamic conditions with the development of cardiometabolic shock.

Recently, the use of ECMO as support during percutaneous complex cardiac interventions has been proposed, especially in high-risk patients. Besides the clinical aspects, also some technical issues have to be taken into account, such as complex anatomies with an extensive ischemic area at risk and severe impaired ventricular systolic function.
