The use of ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatments and cardiac arrests not responding to conventional resuscitation. According to our internal protocol, ECLS was adopted also as a bridge to implantation of Left Ventricular Assist Device or to heart transplantation [15] . ECLS was employed in cases of in-hospital cardiac arrest when the patient was considered to have a good chance of recovery both for clinical conditions and for the timing of resuscitation. An age limit of seventy years, severe irreversible brain damage, terminal malignancy, pre-signed "do not attempt resuscitation" orders and contraindications to prolonged systemic heparin infusion were the only strict exclusion criteria taken into account. In case of cardiac arrest, hypothermia was rapidly initiated and was maintained for 24 hours at a temperature between 32-34°C [16] . Veno-arterial (V-A) ECLS treatment was considered contraindicated, when a severe aortic incompetence, aortic dissection or ventricular thrombosis was detected by echocardiography.