V-V ECMO: Indications and Contraindications:


V-V ECMO should only be considered in patients with preserved cardiac function, who have one or more of the following:

  • Hypoxemic respiratory failure associated with a high mortality rate:
    • Persistently low PF ratio (< 80) despite optimal management with a mechanical ventilator.
  • Hypercapnic respiratory failure:
    • Refractory hypercapnia causing acidosis despite optimal management with a mechanical ventilator.
  • Persistently elevated end-inspiratory plateau pressures despite optimal management with a mechanical ventilator.


Strictly speaking, there are no absolute contraindications to ECMO. Each patient should be considered on a case-by-case basis. However, relative contraindications to V-V ECMO include:

  • Shock resulting from a low cardiac output state:
    • V-V ECMO does not provide hemodynamic support.
  • Severe pulmonary hypertension:
    • Despite improvement in oxygenation and CO2 clearance, V-V ECMO may not be able to support right-sided heart dysfunction.
  • Prolonged high ventilatory pressures (i.e. end inspiratory plateau pressures > 30 cmH2O for longer than 7 days):
    • In this case, the lung parenchyma will probably have sustained such a great deal of injury during this time that it will be unlikely to regain any function.
  • Prolonged elevated oxygen requirements (i.e. FiO2 > 80% for longer than 7 days):
    • Prolonged exposure to oxygen is likely to produce irreversible lung toxicity to the extent that they will be unlikely to recover any function.
  • Recent or expanding haemorrhage:
    • The degree of systemic anticoagulation required will likely exacerbate the haemorrhage.
  • Lack of vascular access.
  • Advanced age:
    • Although there is no strict age cutoff criteria, the older a patient is the worse they will do and this must be factored into the decision.

Common examples of V-V ECMO use at TGH include:

  • ARDS refractory to lung protective ventilation strategies, neuromuscular blockade, and proning.
  • Refractory hypoxemia or hypercarbia in a pre-lung transplant patient.
  • Primary graft dysfunction post lung transplant.
  • Severe asthma or COPD exacerbation.

Next page: V-A ECMO: Indications and Contraindications

Return to icuECMO Home