Patient selection criteria for ECMO
| Hypoxic respiratory failure indications | |
| Acute respiratory distress syndrome due to any cause Bridge to lung transplant Primary graft failure of lung transplant | Pao2/Fio2 < 150 while the patient is receiving Fio2 > 90% and high positive end-expiratory pressure (15–20 cm H2O) Murray score ≥ 2 Inability to maintain airway plateau pressure ≤ 30 cm H2O |
| Hypercapneic respiratory failure indications | |
| Exacerbation of chronic obstructive pulmonary disease Status asthmaticus | Paco2 > 80 mm Hg pH < 7.15 Airway plateau pressure ≤ 30 cm H2O |
| Cardiac failure indications Myocardial infarction-associated cardiogenic shock Fulminant myocarditis Sepsis-associated myocardial depression Extracorporeal cardiopulmonary resuscitation Postcardiotomy or post-heart transplant cardiogenic shock Primary graft failure after heart transplant Bridge to ventricular assist device implantation or heart transplant | |
| Absolute contraindications | |
| Uncontrolled active hemorrhage Terminal illness Irreversible or end-stage heart or lung failure in patients who are not candidates for transplant | |
| Relative contraindications | |
| More than 7 days on mechanical ventilation with high Fio2 or high-pressure ventilation Nonpulmonary organ dysfunction, especially renal failure Irreversible central nervous system dysfunction Malignancy, solid-organ transplant, or immunosuppression Conditions precluding use of anticoagulation Advanced age Weight > 125 kg | |