Introduction: Although outcomes of post-cardiotomy extracorporeal membrane oxygenation (ECMO) are well studied¹, the outcomes of patients bridged to cardiac surgery with ECMO are less well understood. We undertook this study to evaluate our experience with ECMO as a bridge to cardiac surgery.

Methods: We conducted a retrospective review of all patients placed on ECMO prior to cardiac surgery. Patients decannulated prior to surgery were excluded. Patients bridged to advanced heart failure therapies were excluded. The primary outcome was survival.

Results: From 2013-2024, 16 patients were on ECMO at the time of cardiac surgery. All patients were on femoral veno-arterial ECMO. Although most were cannulated for acute heart failure, 1(6%) patient was cannulated for primarily respiratory failure and 2(13%) patients were cannulated with CPR in progress. The average age was 57±13 years and 11(69%) were female. 10(63%) patients underwent valve surgery, 5(31%) underwent ventricular septal defect repair, and 1(6%) underwent coronary artery bypass grafting. The average duration of ECMO support was 8±5 days. 13(81%) patients survived to decannulation and 8(50%) patients survived to hospital discharge.

Conclusions: Although uncommon, preoperative ECMO as a bridge to cardiac surgery can be performed safely with acceptable outcomes. Further investigation in larger databases would help clarify which patients benefit from such high-risk surgery.