Background There has been an increasing use of ECMO as bridge to heart transplant (OHT) or left ventricular assist device (LVAD) over the last decade. Methods Using data from the Extracorporeal Life Support Organization (ELSO) Registry between 2010 and 2019, we sought to describe the demographics, comorbidities, hemodynamics and ECMO-related information for patients bridged with ECMO to OHT or LVAD. We compared in-hospital mortality and length of stay between these groups, identified predictors of undergoing OHT vs LVAD, and then predictors of in-hospital mortality. Results 167 patients underwent LVAD implantation vs. 234 patients who underwent OHT. The mean age was 47.8 ± 14.1 years, mean weight was 82.8 ± 21.9 kgs, 29.2% were women and 56.4% were White. The overall use of ECMO as bridge to either therapy has increased from 1.7% in 2010 to 22.2% in 2019 (p<0.001). In-hospital mortality was similar between groups (LVAD: 28.7% vs OHT: 29.1%, p=0.24) while LOS was longer for OHT (LVAD: 49.6 d vs. OHT: 59.5d, p=0.05). Factors associated with LVAD use included weight (OR=0.98, CI 0.97-0.99; p=0.007), cardiogenic shock presentation (OR=0.40, CI 0.21-0.78; p=0.007), hx of LVAD (OR=0.005, CI 0.0001-0.22; p=0.047), respiratory failure (OR=0.28, CI 0.11-0.70; p=0.007), whereas those for OHT included prior transplant (OR=31.26, CI 3.84-780.5; p=0.007), use of a temporary pacemaker (OR=6.5, CI 1.39-50.15; p=0.033) and increased use of inotropes on ECMO (OR=3.77, CI 1.39-11.07; p=0.011). Older age (OR=1.07, p=0.003), cannulation bleeding (OR=26.1, p=0.0009) and surgical bleeding (OR=6.7, p=0.027) in patients who received LVAD and respiratory failure (OR=5, p=0.031) and CRRT (OR=3.82, p=0.017) in patients who received OHT were associated with increased mortality. Conclusions ECMO use as bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the two groups while length of stay was longer for OHT. There has been an increasing use of ECMO as bridge to heart transplant (OHT) or left ventricular assist device (LVAD) over the last decade. Using data from the Extracorporeal Life Support Organization (ELSO) Registry between 2010 and 2019, we sought to describe the demographics, comorbidities, hemodynamics and ECMO-related information for patients bridged with ECMO to OHT or LVAD. We compared in-hospital mortality and length of stay between these groups, identified predictors of undergoing OHT vs LVAD, and then predictors of in-hospital mortality. 167 patients underwent LVAD implantation vs. 234 patients who underwent OHT. The mean age was 47.8 ± 14.1 years, mean weight was 82.8 ± 21.9 kgs, 29.2% were women and 56.4% were White. The overall use of ECMO as bridge to either therapy has increased from 1.7% in 2010 to 22.2% in 2019 (p<0.001). In-hospital mortality was similar between groups (LVAD: 28.7% vs OHT: 29.1%, p=0.24) while LOS was longer for OHT (LVAD: 49.6 d vs. OHT: 59.5d, p=0.05). Factors associated with LVAD use included weight (OR=0.98, CI 0.97-0.99; p=0.007), cardiogenic shock presentation (OR=0.40, CI 0.21-0.78; p=0.007), hx of LVAD (OR=0.005, CI 0.0001-0.22; p=0.047), respiratory failure (OR=0.28, CI 0.11-0.70; p=0.007), whereas those for OHT included prior transplant (OR=31.26, CI 3.84-780.5; p=0.007), use of a temporary pacemaker (OR=6.5, CI 1.39-50.15; p=0.033) and increased use of inotropes on ECMO (OR=3.77, CI 1.39-11.07; p=0.011). Older age (OR=1.07, p=0.003), cannulation bleeding (OR=26.1, p=0.0009) and surgical bleeding (OR=6.7, p=0.027) in patients who received LVAD and respiratory failure (OR=5, p=0.031) and CRRT (OR=3.82, p=0.017) in patients who received OHT were associated with increased mortality. ECMO use as bridge to advanced therapies has increased over time, with more patients undergoing LVAD than OHT. Mortality was equal between the two groups while length of stay was longer for OHT.