**1. Introduction**

Extracorporeal Membrane Oxygenation (ECMO) has become a vital life-saving technology in the management of advanced heart failure and heart transplant patients. Failure of optimal medical therapy in heart failure shifts the treatment options from neurohormonal modulation to surgery and palliative options. Historically, ECMO was for brief support for periods of 5–10 days however prolonged runs have been reported [1]. Contemporary use in heart failure may be classified as bridge to transplant, bridge to recovery, destination, or bridge to decision.

ECMO is employed pretransplant to provide support to patients with end-stage cardiac failure when conventional optimal medical therapy is insufficient. ECMO can be used in pure cardiac dysfunction with left, right, and biventricular failure, and unlike other mechanical options, in patients with concomitant pulmonary insufficiency due to pulmonary edema ECMO provides respiratory support. Veno-arterial extra corporeal membrane oxygenation (VA ECMO) may be utilized in neonatal, pediatric, and adult

populations, making it a viable support modality for various patient populations. In the postoperative heart transplant patient, primary graft dysfunction is the most common indication for mechanical circulatory support using VA ECMO.
