Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.

Veno-veno-arterial ECMO is a technically feasible rescue strategy in treating patients presenting with combined respiratory and haemodynamic failure.

Aortic arch repair remains a high-risk procedure, especially in multisegment aortic disease. Several peri- and postoperative factors predicted adverse outcome, indicating the need to further improve perioperative management (e.g. organ protection). Indications for FET treatment have to be thoroughly investigated (e.g. FET in CDs).

Patients with high-risk pulmonary embolism (PE) presenting with cardiogenic shock refractory to supportive measures have a high mortality [1, 2]. Therapeutic success depends on rapid haemodynamic stabilisation and restoration of pulmonary blood flow. Thrombolytic therapy is the most widely used recanalisation strategy, but this treatment has substantial drawbacks including a high rate of bleeding complications and limited efficacy in patients with large embolic burden or in patients with recurrent PE presenting with acute-on-chronic events [3-8]. Surgical treatment of massive PE was introduced 110 years ago by Dr. Trendelenburg, but was widely abandoned due to high mortality rates [4, 9]. The unsatisfactory surgical results were often related to the compromised clinical status of the patients, especially those who had already undergone thrombolysis and entered the operation room with advanced cardiogenic shock in need of cardiopulmonary resuscitation (CPR) [1, 2, 9-11]. Thus, the cornerstone for improving the results of surgical embolectomy may lie in the stabilisation of the preoperative haemodynamic condition, which can be achieved by veno-arterial extracorporeal membrane oxygenation (v-a ECMO) [2, 12, 13]. At our institution, in November 2012, we introduced a pulmonary embolism response team (PERT) consisting of pneumologists, cardiologists, radiologists and cardiothoracic surgeons, and a standard operating procedure for patients with high-risk PE. Per protocol, thrombolytic therapy was not to be instituted prior to a PERT decision. v-a ECMO support was the preferred rescue therapy for patients who remained in cardiogenic shock or under CPR despite supportive measures.

Routinely protecting the heart during complex aortic arch repair with non-cardioplegic CMP is a valuable new concept. The CMP technique is feasible and safe, does not prolong aortic arch repair, reduces myocardial damage and improves cardiac outcome. Further evaluation in a larger patient cohort is warranted to establish this novel technique.