Indications for and contraindications to venovenous extracorporeal membrane oxygenation (ECMO) in COVID-19
| ECMO centers should develop individual center-specific inclusion and exclusion criteria and consider patients on a case-by-case basis |
| Indications |
| Severe acute respiratory distress syndrome with PaO2:FiO2 ratio < 100 despite high positive end-expiratory pressure (8–10 cm H2O) and FiO2 > 80% |
| Trial of paralytics and prone positioning attempted |
| Absolute contraindications |
| Advanced age |
| Clinical Frailty Scale category ≥ 3 |
| Terminal disease with short expected survival |
| End-stage malignancy |
| Severe neurologic damage |
| Severe multiorgan failure |
| Mechanical ventilation > 10 days |
| Unable to accept blood products |
| Contraindications to anticoagulation |
| Do-not-resuscitate status |
| Relative contraindications |
| Age ≥ 65 |
| Obesity (body mass index ≥ 40 kg/m2) |
| Multiple comorbid conditions |
| Severe immunosuppression |
| Septic shock |