ECMO Candidate

VA ECMO Indications:

  1. Severe hypothermia (core temp < 28 C) including hypothermic cardiac arrest
  2. Failure to wean from OR cardiopulmonary bypass
  3. Poisoning with refractory cardiogenic shock/malignant arrhythmia
  4. Massive pulmonary embolism with refractory cardiogenic shock
  5. Post-PCI cardiogenic shock
  6. Fulminant myocarditis*
  7. Candidate for VV ECMO plus either jugular vein not accessible and/or high-dose vasopressors**
*Consider early transfer for VAD, heart transplant eval
** Consider hybrid mode (VVA, VAV)
In general, no ROSC… no ECMO (excluding hypothermia)

Please see here for our current statement on evidence regarding refractory normothermic out of hospital cardiac arrest (VF/VT). 

SAVE Score For Survival After Veno-Arterial ECMO

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VV ECMO Indications:

  1. Severe ARDS with…
    1. Refractory hypoxemia (PaO2/FIO2 < 80) despite high FIO2/PEEP, NMB, proning if appropriate, Flolan, etc.
    2. Failing lung-protective ventilation (pH <7.20 with Vt <6 cc/kg and Pplat >35)
  2. Refractory ventilatory failure (e.g. status asthmaticus or air leak syndrome)

RESP Score for Survival After Veno-Venous ECMO

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ECMO Contraindications:

  1. Age > 75 years
  2. Life-limiting co-morbidities (ESRD, ESLD, metastatic cancer) or acute, severe brain injury (e.g. anoxia)
  3. DNR/DNI status
  4. Uncontrollable hemorrhage
  5. If VA ECMO considered… aortic dissection or severe aortic insufficiency
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External Referrals: