Table 1:
Indications/Contraindications for Adult VV ECMO
| Common indications for venovenous extracorporeal membrane oxygenation |
| One or more of the following: |
| 1) Hypoxemic respiratory failure (PaO2/FiO2 < 80 mmHg)*, after optimal medical management, including, in the absence of contraindications, a trial of prone positioning. |
| 2) Hypercapnic respiratory failure (pH <7.25), despite optimal conventional mechanical ventilation (respiratory rate 35 bpm and plateau pressure [Pplat] ≤ 30 cmH2O). |
| 3) Ventilatory support as a bridge to lung transplantation or primary graft dysfunction following lung transplant. |
| Specific clinical conditions: |
| • Acute respiratory distress syndrome (e.g. viral / bacterial pneumonia, aspiration) |
| • Acute eosinophilic pneumonia |
| • Diffuse alveolar hemorrhage or pulmonary hemorrhage |
| • Severe asthma |
| • Thoracic trauma (e.g. traumatic lung injury, severe pulmonary contusion) |
| • Severe inhalational injury |
| • Large bronchopleural fistula |
| • Peri-lung transplant (e.g. primary lung graft dysfunction, bridge to transplant) |
| Relative contraindications for venovenous extracorporeal membrane oxygenation (VV ECMO) |
| • Central nervous system hemorrhage |
| • Significant central nervous system injury |
| • Irreversible and incapacitating central nervous system pathology |
| • Systemic bleeding |
| • Contraindications to anticoagulation |
| • Immunosuppression |
| • Older age (increasing risk of death with increasing age, but no threshold is established) |
| • Mechanical ventilation for more than 7 days with Pplat > 30 cmH2O and FiO2 > 90% |