Table 1.
Framework for Prioritizing Common ECMO Indications During a Disaster, by Predicted Survival and Duration of Support
| Tier (Predicted Survival) | Short Duration ECMO Anticipated (≤ 5 d) | Long Duration ECMO Anticipated (> 5 d) |
|---|---|---|
| Tier 1 (> 60%) | Acute hypercarbic respiratory failure because of status asthmaticus | Acute respiratory failure because of infection (especially influenza or coronavirus) with single organ failure |
| Cardiac arrest or cardiogenic shock because of severe accidental hypothermia (ie, extracorporeal rewarming) | Acute respiratory failure because of trauma (drowning, pulmonary contusion, etc) with single organ failure | |
| Pediatric pre- and postcardiotomy cardiogenic shock | Pediatric myocarditis | |
| Neonatal meconium aspiration syndrome | Other neonatal indications (including sepsis, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn) | |
| Tier 2 (30%-60%) | Poisoning-induced cardiogenic shock | Acute respiratory failure from any cause with multiorgan failure (including kidney injury requiring dialysis or hypotension requiring vasopressor support) |
| Massive pulmonary embolism | Pediatric/neonatal cardiac arrest from a cardiac etiology | |
| Tier 3 (< 30%) | Adult postcardiotomy cardiogenic shock | Bridge to lung transplantation for irreversible respiratory failure |
| Out-of-hospital, refractory cardiac arrest with favorable prognostic features (ie, extracorporeal CPR) | Acute respiratory failure and severe immunocompromise (eg, stem cell transplant < 240 d posttransplant) | |
| Cardiac arrest with nonshockable rhythm or unfavorable prognostic features (including most adults with in-hospital cardiac arrest) | Cardiovascular collapse refractory to vasopressors in the setting of multiorgan failure of any cause (eg, septic shock) |
ECMO = extracorporeal membrane oxygenation.