Mori M, McCloskey G, Geirsson A, et al. - In view of the necessity for effective strategies to optimize Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS 1) patients, researchers examined the outcomes of patients with awake venous-arterial extracorporeal membrane oxygenation (aVA ECMO) support before durable left ventricular assist device (LVAD) implantation. aVA ECMO enables clinical evaluations while temporarily supporting biventricular function and stabilizing end-organ functions. Among 83 patients receiving durable LVAD in 2012–2015, aVA ECMO support was used in 19 before durable LVAD. They identified no complications during the mean aVA ECMO support of 2.7 days. As per the multivariate analysis, the risk of death reduces significantly in correlation to providing aVA ECMO support compared with those in INTERMACS 1 non-aVA ECMO group. Findings suggest that in INTERMACS category 1 patients, awake venous-arterial (VA) ECMO allows bridge to next therapy and improves outcomes with an effect comparable with downgrading the disease severity on the INTERMACS scale.