Table 1.

Proposed indications and contraindications to ECMO for ARDS

Indications	Relative contraindications	Absolute contraindications
EOLIA entry criteriaa PaO2/FiO2 < 50 mmHg for > 3 h PaO2/FiO2 < 80 mmHg for > 6 h pH < 7.25 with a PaCO2 ≥ 60 mmHg for > 6 hb	Invasive mechanical ventilation for more than 7–10 days Contraindication to anticoagulation Severe coagulopathy Advanceed age Salvage ECMO (referred to as “rescue” in EOLIA), i.e., employing ECMO when severe right heart failure, or other severe decompensation occurs	Moribund state with established multiple organ failure Prolonged cardiac arrest Severe anoxic brain injury Massive intracranial hemorrhage Severe chronic respiratory failure with no possibility of lung transplantation Metastatic malignancy or hematological disease with poor short-term prognosis Other advanced comorbidities with poor short-term prognosis

^aAfter proven conventional management (including lung protective mechanical ventilation, prone positioning and possibly neuromuscular blockade) for severe ARDS have been applied and failed. Less frequently, rescue ECMO may be deployed when a patient is too unstable for prone positioning, or when this is the only way to facilitate safe transport from a non-expert centre that is unable to apply evidence-based conventional practices

^bWith respiratory rate increased to 35 breaths per minute and mechanical ventilation settings adjusted to keep a plateau airway pressure of ≤ 32 cm of water