Purpose Historically, survival after heart transplantation (HT) has been inferior among patients bridged with ECMO. With the recent changes in US heart allocation policy, VA-ECMO is now a status 1 indication for HT. We sought to explore the potential implications of these changes by evaluating outcomes among patients bridged to HT with ECMO. Methods We sampled HT recipients enrolled through the UNOS database from 1987 to 2017. Re-transplants were excluded, and patients were divided into two age groups: 18 years (adults ). Patients in each age group were categorized as those bridged with ECMO vs No-ECMO, and demographics between ECMO and No-ECMO patients were analyzed with Wilcoxon and Chi-Square tests . Overall survival time was analyzed with Kaplan-Meier, and compared between groups using Log-rank tests. Survival was also assessed >90 days post-transplant. Results Our sample consisted of 8,334 juveniles (414 ECMO, 7,920 No-ECMO), mean age 6.1 years and 56,013 adults (189 ECMO, 55824 No-ECMO), mean age 52.1 years. In both groups, recipient and donor ages differed between ECMO and No-ECMO patients (p 90 days). Conclusion Survival after HT with ECMO bridging is significantly lower among both juveniles and adults, though differences disappeared after 90 days. Limitations include small number of adults undergoing ECMO bridging. In light of the new HT allocation policy, as well as a lack of donor organs and notable waitlist mortality, alternate bridging options could be considered. This is particularly true among adult populations, where other options exist.