**Abstract**

Extracorporeal membrane oxygenation (ECMO) use in patients both pre and post heart transplantation has become a life-saving tool in the armamentarium for physicians. Early developments in perfusion were hindered by the challenges of coagulation. Technological advances leading to contemporary management of ECMO began with the oxygenation of blood circulating through an artificial cistern. VA ECMO provides mechanical circulatory support (MCS) to patients not responding to medical treatment with primary cardiac dysfunction or combined respiratory and cardiac dysfunction failure. Management of the patient on ECMO is complex and involves multidisciplinary daily input from cardiology, cardiac surgery, and intensivist with ECMO specialization. Indications for ECMO use in heart transplantation include bridge to decision, bridge to transplant, rescue from PGD, and management of vasoplegia. The use of ECMO pre transplant has increased in the United States since the heart allocation changes implemented in 2018. Outcomes utilizing ECMO in pre and post heart transplant patients appear to be improving worldwide.

**Keywords:** ECMO, heart transplantation, shock, mechanical circulatory support, advanced heart failure
