Table 2.

Neonatal ECMO indications and contraindications (adapted from the ELSO Guidelines for Neonatal Respiratory Failure 2017 [22] and ELSO Guidelines for Pediatric Cardiac Failure 2018 [24])

Neonatal respiratory ECMO

1. Oxygenation index (OI) > 40 for > 4h $\mathrm{OI}=\frac{\text{Mean Airway pressure}\times {\mathrm{FiO}}_2\times 100}{\text{Post ductal}{\mathrm{PaO}}_2}$

2. Failure to wean from 100% oxygen despite prolonged (> 48 h) maximal medical therapy or persistent episodes of decompensation

3. Severe hypoxic respiratory failure with acute decompensation (PaO2 < 40 mmHg) unresponsive to intervention

4. Severe pulmonary hypertension with evidence of right ventricular dysfunction and/or left ventricular dysfunction

5. Pressor-resistant hypotension

Neonatal cardiac ECMO

1. Low cardiac output with evidence end-organ malperfusion despite maximal medical therapy

2. Refractory hypotension

3. Low cardiac output with increasing lactates levels (> 4 mmol/L)

4. Low cardiac output state with mixed venous oxygen saturation (or superior central venous oxygen saturation for single ventricles patients) < 50%

Absolute contraindications

1. Lethal chromosomal disorder1 or another lethal anomaly

2. Irreversible brain damage

3. Uncontrolled bleeding

4. Grade III or greater intraventricular hemorrhage

Relative contraindications

1. Irreversible organ damage (unless considered for organ transplant) 2. Weight < 2 kg 3. Postmenstrual age < 34 weeks 4. Mechanical ventilation > 10–14 days

¹Includes trisomy 13 and trisomy 18 (not trisomy 21)