- General indications for veno-venous (VV) extracorporeal membrane oxygenation (ECMO).
| Contraindications for VV ECMO for respiratory failure: |
| The following are some of the contraindications for ECMO in patients with severe Acute Respiratory Distress Syndrome that should be considered before referral: |
| Absolute |
| Circulatory collapse requiring cardiopulmonary resuscitation for >15 min (no extracorporeal cardiopulmonary resuscitation). |
| Contradictions for anticoagulation (active bleeding or recent major surgery). |
| Poor baseline functional status (Eastern Cooperative Oncology Group score 0-2).1 (Appendix A) |
| Significant comorbidities associated with poor outcomes: |
| Neurological (such as, stroke within the last 6 months, seizure disorder, dementia). |
| Respiratory (such as, severe chronic obstructive pulmonary disease [COPD], pulmonary fibrosis, cystic fibrosis). |
| Cardiac (such as, severe heart failure with left ventricular election fraction <30% from any cause, history of major cardiac intervention). |
| Gastrointestinal (such as, severe short gut syndrome, Crohn’s disease, ulcerative colitis). |
| Hepatological (such as, liver cirrhosis with child-pugh B or C). |
| Advanced solid organ malignancy (such as, advanced-stage colon cancer). |
| Severe peripheral vascular disease. |
| Severe liver failure with elevated International Normalized Ratio and derangement of liver enzymes. |
| Poor neurological status (due to intracranial bleeding, cerebrovascular accident, or others). |
| Relative |
| Prolonged high setting mechanical ventilation (>7 days). |
| Age >65 years. |
| Left ventricular ejection Fraction <30% with no previous history of low ejection fraction. |
| Renal (such as, end-stage renal disease on hemodialysis). |
| Morbid obesity (body mass index > 35 kg/m2). |
| Immunocompromised status (such as, post-renal transplant). |
| Hematological malignancies within the last 5 years. |