Table 1.
Indications and contraindications for VV ECMO
| Indications |
| Endotracheal intubation and mechanical ventilation < 7 days |
|
Hypoxic respiratory failure due to any cause when the predicted mortality risk is > 80%: - PaO2/FiO2 ≤ 50 mmHg for > 3 h - PaO2/FiO2 ≤ 80 mmHg for > 6 h - Arterial blood pH of < 7.25 with a PaCO2 ≥ 60 mmHg for > 6 h, with the RR increased to 35 bpm) [Mechanical ventilation settings adjusted to keep a Pplat ≤ 32 cmH2O despite ventilator optimization (FiO2 ≥ 0.80, a VT 6 ml/Kg of PBW and a PEEP ≥ 10 cmH2O)] |
| Severe air leak syndrome |
| Need for intubation in patients on lung transplant list |
| Absolute contraindications |
| Irreversible lung disease |
| Relative contraindications |
| Age ≥ 65–70 y |
| Immunocompromised status |
| No legal medical decision-maker available |
| Advanced chronic systolic heart failure |
| Clinical Frailty Scale Category ≥ 3 |
| Significant comorbidities |
| - CKD ≥ III |
| - Cirrhosis |
| - Dementia |
| - Baseline neurologic disease precluding rehabilitation potential |
| - Uncontrolled diabetes with chronic end-organ dysfunction |
| - Severe deconditioning |
| - Protein-energy malnutrition |
| - Severe peripheral vascular disease |
| - Other life-limiting medical illness |
| - Non-ambulatory status |
| Severe multiple organ failure |
| Severe acute neurologic injury, e.g., anoxic, stroke |
| Uncontrolled bleeding or contraindication to anticoagulation |
| Inability to accept blood products |
| Ongoing CPR |
MV: mechanical ventilation; PaO2/FiO2: ratio of arterial oxygen partial pressure to fractional inspired oxygen; PaCO2: arterial carbon dioxide partial pressure; RR: respiratory rate; bpm: breaths per minute; Pplat: plateau pressure: VT: tidal volume; PBW: predicted body weight; PEEP: positive end-expiratory pressure; CKD = chronic kidney disease; CPR: cardio pulmonary resuscitation