ECMO provides a good temporary cardiopulmonary support in patients with postcardiotomy shock. The preoperative risk factors of failure to withdraw ECMO are poor left-ventricular ejection fraction, systolic blood pressure <90 mmHg and refractory severe metabolic acidosis. The peri-ECMO predictors of mortality include low serum albumin level, low platelet count, low oxygen pressure of the venous tube of the ECMO and poor cardiac systolic function.

Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.

The shortage of organ donors remains a major problem for transplantation worldwide. Potential donors after brain death may become hemodynamically unstable, despite maximal medical management, which ultimately leads to failure of organ procurement. We reviewed the medical records of five brain-dead potential donors who presented with hemodynamic instability despite maximal medical management that were supported by extracorporeal circulation membrane oxygenation (ECMO). The outcomes of heart recipients were reviewed. The five donors under extracorporeal support finished a declaration of brain death without cardiac arrest. Donor organs, including three hearts, nine kidneys, and four livers, were harvested from the five donors under ECMO support. All three heart recipients recovered uneventfully after one yr of follow-up. Our experience indicates that potential donors may experience central-failure-related hemodynamic instability after brain death, despite maximal medical support, which leads to a fatal result. Beyond medical management, prompt and early extracorporeal support for salvaging brain-dead potential donors from cardiac death seems to be a practical strategy to increase the donor pool and preserve donor organs.