From the Guidelines
Extracorporeal membrane oxygenation (ECMO) is indicated for patients with severe cardiac or respiratory failure who are unresponsive to conventional management but have potentially reversible conditions, such as severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia, cardiogenic shock, or cardiac arrest requiring prolonged CPR. The primary indications for ECMO include:
- Severe ARDS with refractory hypoxemia despite optimal ventilator management
- Cardiogenic shock unresponsive to inotropes and vasopressors
- Cardiac arrest requiring prolonged CPR
- As a bridge to heart or lung transplantation Specific clinical scenarios include post-cardiotomy shock, massive pulmonary embolism, severe pneumonia, and primary graft dysfunction after transplantation, as noted in studies such as 1. ECMO is typically considered when the predicted mortality exceeds 80% despite maximal conventional therapy. For respiratory failure, criteria often include a PaO2/FiO2 ratio <80 mmHg despite optimal PEEP and FiO2, severe respiratory acidosis with pH <7.15, or Murray score >3, as discussed in 1. For cardiac support, indications include inability to wean from cardiopulmonary bypass, cardiac index <2 L/min/m² despite high-dose inotropes, or refractory ventricular arrhythmias. ECMO provides temporary cardiopulmonary support by removing deoxygenated blood, oxygenating it externally, and returning it to the patient's circulation, allowing time for recovery or serving as a bridge to definitive therapy. Patient selection is crucial, as ECMO carries significant risks including bleeding, thrombosis, infection, and vascular complications, highlighting the need for careful consideration and institutional guidelines, as suggested in 1.
From the Research
Indications for Extracorporeal Membrane Oxygenation (ECMO)
The indications for ECMO include:
- Severe cardiac or respiratory failure that is potentially reversible 2, 3, 4, 5, 6
- Refractory cardiogenic shock 6
- Refractory ventricular arrhythmia 6
- Active cardiopulmonary resuscitation for cardiac arrest 6
- Acute or decompensated right heart failure 6
- High-risk structural heart interventions 2
- Ventricular tachycardia ablation 2
- Cesarean section 2
- Trauma 2
- Non-cardiac elective procedures in patients at high risk for perioperative cardiac or respiratory complications 2
- Severe, life-threatening respiratory failure, including acute respiratory distress syndrome (ARDS) 3, 4
Patient Selection Criteria
Patient selection criteria for ECMO include:
- PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours, as per the Extracorporeal Life Support Organization (ELSO) Guidelines 3
- Severe respiratory failure that is unresponsive to conventional therapies 3, 4
- Cardiac failure that is unresponsive to conventional therapies 6
ECMO Support Types
ECMO can provide different types of support, including: