INDICATIONS and CONTRAINDICATIONS for ECMO

           INDICATIONS FOR ECMO
  • Non-cardiogenic respiratory failure. Potentially reversible (Pneumothorax / large pleural effusion drained, trial of diuresis).
               IF: Optimal ventilation (including PEEP >10cmH2O)
                 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


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