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

Clinics

ECMO: Heart and Lung Life Support