V-A ECMO: Indications and Contraindications:


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


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

Return to icuECMO Home