Indications and Contraindications for ECMO:

Before getting into specific indications for ECMO, it is important to know that ECMO is not a permanent solution. It should be treated in the same way we approach any therapy in the ICU.

If a patient has an underlying condition or severe organ dysfunction that would limit the overall benefit from ECMO, then it should not be offered.

Additionally, patients should only be considered for ECMO if one of these conditions is met:

  • Bridge to recovery: The underlying pathology is reversible and ECMO will be used to support them until their condition resolves.

    For example, if a patient has severe ARDS, ECMO may be considered to provide oxygenation until the patient's lungs improve.

  • Bridge to transplantation: ECMO will provide the means to a more definitive solution.

    For example, if a patient has pulmonary fibrosis and is listed for lung transplantation and decompensates while waiting for lungs to become available, ECMO may be used to provide oxygenation and CO2 removal while the patient waits for donor lungs to be available.

  • Bridge to advanced therapy: ECMO will provide the means to a more definitive solution.

    For example if a patient has acute decompensated heart failure, then ECMO support may be used as a way of temporarily supporting the patient's hemodynamics until a more permanent device (e.g. an LVAD) is available.

  • Bridge to decision: The use of ECMO will allow for the patient to be evaluated for consideration of advanced therapy.

    For example, if a patient has decompensated heart failure, they may be placed on ECMO to provide cardiovascular support while the transplant team completes their transplant work up to assess the patient for candidacy.

Whether the patient is a candidate for V-A ECMO vs V-V ECMO depends on the clinical scenario. The following indications are adopted from the Extracorporeal Life Support Organization.

Next page: V-V ECMO: Indications and Contraindications

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