differences between preoperative and postoperative settings must be highlighted. In fact, along with the recovery of end-organ function, some other complications can occur preoperatively.Glick and colleagues [2] described that 60% of patients undergoing ECMO have thrombocytopenia, and the lowest platelet count was recorded by the third day after ECMO implantation. Moreover, those patients with suspected heparin-induced thrombocytopenia (HIT), even if it was not yet diagnosed, had significantly higher mortality (p < 0.01) compared with patients with stable platelet counts during this mechanical support. Furthermore, the diagnosis of HIT implies the immediate discontinuation of heparin and the use of other drugs for cardiopulmonary bypass, such as bivalirudin, that do not have any reversal agents in the intraoperative setting. This situation can ultimately result in a higher risk for intraoperative bleeding. Thus, the occurrence of HIT can be more deleterious in the preoperative setting than postoperatively. Given the low number of patients in the report by Glick and colleagues [2], this complication was fortunately not reported.However, in light of this potential problem we believe that the benefit of preoperative ECMO for recovery of end-organ function must be cautiously weighed against the risk of preoperative thrombocytopenia.