A 57-year-old male patient with dilated cardiomyopathy and congestive heart failure is admitted with severe heart failure. He was intubated on admission to ICU, due to severe biventricular dysfunction, his BP was very low even with high-dose inotropes. The family was counselled about the condition of the patient, and given an option of VA ECMO followed by Heart transplant or VAD. The family agreed to ECMO, so the patient was put on VA ECMO and stabilized, on the 4^th day patient started showing improvement with VA ECMO support. He was waiting for a donor’s heart to get a heart transplant for the next 18 days. Unfortunately, he couldn’t get a donor’s heart. They were given the second option of LVAD now which the family accepted. Patient family education followed while the process started for LVAD implantation.