V-A ECMO: Indications and Contraindications:
Indications
V-A ECMO should be considered in cases of:
- Inadequate tissue perfusion resulting from a low cardiac output state despite volume resuscitation, inotrope and vasopressor support, and mechanical support if appropriate.
- Malignant cardiac arrhythmias refractory to antiarrhythmic therapy.
- Severe pulmonary hypertension with hypoxemia or end organ hypoperfusion despite pulmonary vasodilator therapy:
- In patients with end stage pulmonary hypertension who require intubation, V-A ECMO is often started before intubation because of how likely they are to decompensate in the peri-intubation period.
- Septic shock refractory to volume resuscitation, inotrope and vasopressor support:
- At TGH, V-A ECMO is not used for septic shock, however other ECMO centers will use it in select cases.
- Cardiac arrest::
- Some centers perform ECMO during CPR (called ECMO-CPR) for patients with undifferentiated cardiac arrest.
- This is not currently an indication for ECMO at TGH
Contraindications
Relative contraindications to V-A ECMO include:
- Unrecoverable cardiac function and not a candidate for transplant or advanced therapies (e.g. VAD).
- Recent or expanding haemorrhage.
- Aortic dissection.
- Aortic valve incompetence.
- Prolonged CPR without adequate end organ perfusion.
- Lack of vascular access.
- Advanced age.
Common examples of V-A ECMO use at TGH include:
- Decompensated heart failure as a bridge to heart transplantation or insertion of a VAD.
- End stage pulmonary hypertension while awaiting lung transplantation.
- Myocarditis with cardiogenic shock.
- Intraoperative hypoxemia or severe pulmonary hypertension during lung transplantation.
- Myocardial stunning post cardiopulmonary bypass.
Next page: Starting ECMO: Preparation