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ECMO Indications and Exclusions in Life-Threatening Cardiac and Respiratory Failure

ECMO (Extracorporeal Membrane Oxygenation) is crucial for managing potentially reversible, life-threatening respiratory and cardiac failures unresponsive to conventional treatments. It is indicated for patients under 50 or those over 65 with specific weight parameters or severe chronic organ failures. Key exclusions include irreversible cardiac failure without VAD or transplantation options, severe acute brain injuries, advanced septic shock, and significant organ dysfunction. Proper patient selection is essential to optimize outcomes in this complex intervention.

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ECMO Indications and Exclusions in Life-Threatening Cardiac and Respiratory Failure

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  1. ECMO is indicated for potentially reversible, life-threatening forms of respiratory and / or cardiac failure which are unresponsive to conventional therapy Irreversible forms of cardiac failure with option of VAD and Transplantation. (Age under 50) Inclusion: Or Age >65 Weight <20 or >180Kg Presence of additional severe chronic organ failure (liver, lung or renal) Presence of severe acute brain injury Severe chronic pulmonary artery hypertension (even first presentation) with right ventricular failure and PAP(sys) > SBP Malignancy Exclusion (All forms ECMO): Exclusions for VA (Cardiac) ECMO Support: Exclusions for VV (Resp) ECMO Support: Cardiac arrest: initial cardiac rhythm asystole or > 60 minutes to ROSC (or ECMO commencement) Un-repaired aortic dissection Un-repaired moderate - severe aortic or mitral valve regurgitation Heart transplant: chronic rejection Late Cardiogenic Shock - Process too advanced (≥ 2) Lactate > 10 Advanced microcirculatory failure with severe mottling or established purpura AST or ALT > 2000 Anuria > 4 hours Immunosuppressed Lung transplant > 30 days (Other) Transplant recipients (heart, renal, bone marrow) Burns greater than 50% or involving groins Advanced Septic shock - Process too advanced (≥ 2) Lactate > 10 Noradren > 1.5µg/Kg/min Severe myocardial depression Advanced microcirculatory failure with severe mottling or established purpura

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