A new article published in Current Opinion in Cardiology provided an update on recent advances in extracorporeal membrane oxygenation ECMO and ventricular assist devices VADs management in children. The article reported that the options for mechanical support in infants and small children with end stage heart failure are limited. The greatest advances in the past decade have come in the successful adoption of the Berlin Heart EXCOR device with a marked improvement in survival to transplant over ECMO. Further advances have been made in the use of adult VADs in children. For instance the HeartWare HVAD has been utilized in children as young as 3 years of age despite being designed for use in adult patients. It was inferred that the availability of mechanical support options for children remains limited to ECMO and a small number of VADs. It was stated that although outcomes of VAD support in pediatric patients have been promising further study in smaller in more complex pediatric patients were recommended in this direction.