Criteria for ECMO

Adult Patient Criteria

Common Adult Diagnoses/Indications

• Influenza
• Viral/Bacterial Pneumonia
• Burn and Inhalation Injury
• Traumatic Lung Injury
• Pulmonary Contusion
• Pulmonary Embolism
• Post-Shock or Sepsis associated with ARDS, or other forms of reversible acute lung injury or illness
• Acute Respiratory Distress (ARDS)

Contraindications

• Mechanical ventilation at high settings (FIO2 > 0.9, P-plat > 30) for > 7 days.
• Unwitnessed arrest
• Total arrest time >60 min
• Chest compressions not initiated within 10 minutes of arrest
• Pre-existing sever neurological disease or injury prior to arrest
• Age: no specific age contraindication but consider increasing risk with increasing age

Call Early If

• Considering proning
• Adding paralytic agent
• Increasing mechanical ventilation
• Patient still has single organ failure

Pediatric Patient Criteria

Common Pediatric Diagnoses/Indications

• Best within first 7 days of mechanical ventilation at high settings
• Influenza
• ARDS
• PE
• Status Asthmaticus
• Cardiac Failure
• Myocarditis
• Cardiomyopathy
• Drug overdose
• Refractory Pulmonary Hypertension
• Malignant arrhythmias
• Witnessed arrest
• Sepsis

Relative Contraindications

• Any infant considered old and large enough to undergo a cardiac operation is an appropriate candidate for ECLS.
• Futility
• CPR > 5 min without evidence of being effective

Neonate Patient Criteria

Common Neonatal Diagnoses/Indications

• Oxygenation Index > 40 for >4 hours

Relative Contraindications

• Oxygenation Index: Mean airway P x FiO2 x 100 ÷ Post ductal PaO2
  • Oxygenation Index >20 with lack of improvement despite prolonged (>24h) maximal medical therapy or persistent episodes of decompensation
  • Severe hypoxic respiratory failure with acute decompensation (PaO2 <40) unresponsive to intervention.
  • Progressive respiratory failure and/or pulmonary hypertension with evidence of right ventricular dysfunction or continued high inotropic requirement
  • Lethal chromosomal disorder (Trisomy 13 and 18)
  • Irreversible brain damage
  • Grade III or greater ICH
  • Irreversible organ damage (unless considered for organ transplant),
  •  <1.6 Kg birth weight
  • <34 weeks post-menstrual age because of the increased incidence of increased intracranial hemorrhage.
  • Disease states with a high probability of a poor prognosis
  • Ventilation with 100% oxygen for >/= 14 days
  • Lower grade ICH