We present the case of a 46-year old male with end-stage heart failure due to ethyltoxic cardiomyopathy. The patient did not meet the criteria for heart transplantation and declined left ventricular assist device implantation. We decided to conduct cardiac resynchronization therapy defibrillator (CRT-D) implantation. Under general anaesthesia for CRT-D implantation, cardiac function worsened. Due to deteriorating haemodynamics, CRT-D implantation was aborted and emergent veno-arterial extracorporeal membrane oxygenation (ECMO) implantation was performed. Subsequent weaning from ECMO was not possible. We decided to proceed with CRT-D implantation while still on ECMO support. With biventricular stimulation, cardiac function improved promptly and the patient could be weaned from ECMO the same day.
