**7. Indications for ECMO bridge to transplant**

Indications for ECMO bridge to transplant are not different from published indications for mechanical circulatory support, namely, advanced heart failure with progression of failure despite optimal medical therapy. The American Heart Association admits that there is no consensus on the definition of advanced heart failure [51]. This leaves practitioners to identify patients with advanced heart failure by the presence of subjective features such as the requirement for critical care,

## *Extracorporeal Membrane Oxygenation (ECMO) Use in Heart Transplantation DOI: http://dx.doi.org/10.5772/intechopen.114126*

continuous ionotropic requirements, and consideration for heart transplantation, MCS, or hospice. Objective assessments, where used, include measures of functional limitation such as peak Vo2 of ≤14 (or < 50% of expected) mL/kg/min and a 6-minute walk of less than 300 meters. In practice, it is often not feasible to determine these objective assessments at the time the decision to institute ECMO support is made. The ideal scenario would be for the shock team to make the decision even in emergent cases, based on the clinical state of the patient.

After failure of medical therapy, options for effective therapy are limited to mechanical circulatory support, heart transplant and palliative care. Due to the scarcity of donor organs, temporary or durable mechanical circulatory support becomes the default option in the absence of donor hearts. When patients require both cardiac and pulmonary support, VA ECMO is the only option.
