Extracorporeal life support (ECLS) provides a parallel circulation, with complex interaction with the native systemic and pulmonary circulation. Left ventricular distension is a complication of ECLS and (surgical and percutaneous) left ventricular decompression should be considered early to avoid lung injury and thrombosis. The survival after veno-arterial-extracorporeal membrane oxygenation score has been developed to predict outcomes from ECLS.