INDICATIONS and CONTRAINDICATIONS for ECMO
INDICATIONS FOR ECMO
- Non-cardiogenic respiratory failure. Potentially reversible (Pneumothorax / large pleural effusion drained, trial of diuresis).
Consider PCV or CMV:
VT < 8ml /kg (ideal body weight),
prone ventilation,
recruitment manouevre.
BUT: PaO2 / FiO2 < 80mmHg
or pH < 7.25
for > 2 hours
- Cardiogenic shock of any aetiology. Potentially reversible OR candidate for destination therapy. Refractory to maximal medical Rx.
- Fulminant myocarditis requiring inotropes or IABP at any time( left heart failure + aseptic febrile illness < 2 weeks, marked troponin elevation, abnormal ECG and / or arrhythmia)
ABSOLUTE CONTRAINDICATIONS TO ALL FORMS OF ECMO
Significant pre-existing co-morbidity, such as irreversible neurological condition, Child-Pugh B or worse cirrrhosis
(ascites, hepatic encephalopathy or recent variceal haemorrhage), active malignancy with predicted limited survival.
ABSOLUTE CONTRAINDICATIONS TO VENO-VENOUS ECMO (for respiratory failure)
- Severe pulmonary hypertension (mPAP > 50mmHg)
- Severe right or left heart failure (EF < 25%)
ABSOLUTE CONTRAINDICATIONS TO VENO-ARTERIAL ECMO (for cardiac failure)
- Severe aortic valve regurgitation
