Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Transplantation

Extracorporeal membrane oxygenation (ECMO) is a technique used for tempo-rary support of patients with end-stage heart or lung failure. This review will focus on the venoarterial ECMO system and its use as a bridge to other long-term durable devices and/or cardiac transplantation. It can be used as a bridge to decision because it helps to gain time to stabilize the patient for further evaluation for long-term treatment such as durable mechanical circulatory pumps or transplantation. ECMO is evolving as a treatment for patients waiting on the transplant list. Increasing utilization of ECMO in adults has revealed some of the common complications such as bleeding and coagulopathy which impact survival in this patient population. The use of VA ECMO as a technique for rescuing patients from cardiogenic shock is very attractive. However, considering the extensive set of complications and the mortality it brings with it makes it a less attractive option as a direct bridge to cardiac transplant. The literature currently on this subject is very scanty and limited to a few studies of small numbers of patients. Further definitive research is needed for consensus on the role of VA ECMO as a bridge to cardiac transplant.