**5.1 Bridge to decision**

In patients presenting in cardiogenic shock, emergency ECMO may be used to resuscitate and support the cardiovascular system while the patient is evaluated for multiple decision pathways including transplant, durable MCS, shifted palliative care or achieve recovery from shock and are weaned off VA ECMO. The availability and speed of deployment of VA ECMO makes it the circulatory support device of choice in emergent potentially terminal cardiac events such as refractory ventricular fibrillation arrests, refractory cardiogenic shock, and pulseless electrical activity. Use of ECMO prior to determination of subsequent treatment options, which may include transplantation, is referred to as bridge to decision. It is notable that, in a significant proportion of patients, sufficient recovery occurs to allow weaning from the ECMO support [13].
