Introduction: Short-term mechanical circulatory support using extracorporal membrane oxygenation (ECMO) is indicated in the acute and rapidly deteriorating stage of heart failure (HF) or cardiogenic shock. Although the use of ECMO is ubiquitously, there is still no solid medical evidence that it improves survival. (1, 2) Objective: To show the importance of identifying optimal candidates for ECMO implantation and critical thinking when establishing ECMO program.

Patients and Methods: We conducted a retrospective analysis of patients with HF in whom ECMO was used in the period 2011-2016 (31 men, age 54 ± 14.8 years). The most common indication for ECMO was acute HF within the acute coronary syndrome (ACS) (13 cases), followed by the deterioration of patients status in the context of dilatative (10 cases), ischemic (7) and infiltrative (3) cardiomyopathy (CMP) and other (5). 31 ECMO implants were taken in the stage INTERMACS (ICS) 1, while the remaining units were installed in the ICS 2 stage HF. 19 procedures were conducted in patients in the active stage of cardiopulmonary resuscitation procedure (E-CPR).

Results: Total number of survived patients is 8 (21%). In 20 patients (53%) ECMO was successfully removed. Statistically, significantly worse survival was in patients who had ECMO within the E-CPR (31%) compared to the others (74%, p = 0.042). With the aim of identifying optimal patient, the above observed period was further divided into two parts - the first (2011-2015) and the second part (2015-2016). At the beginning of 2015, a review of the outcomes (success of ECMO 38%) resulted in a change of paradigm: ECMO was often placed in the ICS 2 stage and in patients with ACS. Such analysis could conclude that the success of ECMO in the second period is even 83%.

Conclusion: Extracorporal membrane oxygenation represents short-term support and is designed as a bypass method to complete healing or to other modalities of treatment. Because of this, it is important, when making a decision on setting up the ECMO, to be critical to their own abilities, and to the potential recovery of patients – perceive the whole situation and plan further steps of treatment.