Table 4.

Indications and contraindications for ECMO use in COVID-19 patients.

Indications

Refractory hypoxemia and worsening hypercapnia despite optimal ventilation strategies (neuromuscular blockade, prone positioning, high PEEP, and inhaled nitric oxide) Mechanical ventilation <7 days Should be considered when risk of death is estimated to be greater than 50% and start when it reaches or exceeds 80% Severe air leak syndrome Complicated with severe myocarditis or cardiogenic shock

Contraindications

Absolute Significant or multiple comorbidities that cannot be recovered Severe immunosuppression Sepsis and bacteremia Contraindications to systemic anticoagulation Severe multiple organ failure Severe aortic dissection Acute intracerebral hemorrhage Irreversible severe brain damage Critical congenital heart disease Chronic lung disease/uncontrolled metastatic disease Lethal chromosomal anomalies (e.g., trisomy 13 or 18) Relative Age ≥65 years Obesity (BMI > 30) Prolonged ventilatory support Frailty Allosensitization with prolonged waitlist time Limitations in vascular access