Indications for ECMO
Indications respiratory and generally intense
- Patients with respiratory failure for whom sufficient oxygenation cannot be ensured in any other way (eg severe acute respiratory distress syndrome, especially of non-traumatic origin, influenza pneumonitis, etc.).
- Hypoxic respiratory failure with PaO2 / FiO2 <150, Murray LIS 2-3 is a situation suitable for consultation with the ECMO center.
- The indication for ECMO implantation is hypoxic respiratory failure with PaO2 / FiO2 <80, Murray 3-4.
- It is also an indication of CO2 retention with PaCO2> 80 mmHg, air-leak (barotrauma), loss / blockage of airway, etc.
- Patients in a severe clinical condition for other reasons requiring transient circulatory support (eg acute pulmonary embolism, accidental hypothermia, periporous cardiomyopathy, etc.).
- Patients before high-risk coronary or structural intervention (due to the nature of the intervention or comorbidities).
- Patients before ablation of malignant arrhythmia who are hemodynamically compromised by this arrhythmia.
- Hemodynamic breakdown / cardiac arrest during coronary or structural intervention.
- Cardiogenic shock after acute myocardial infarction with developing multiorgan dysfunction refractory with routine pharmacological support.
- Severe hemodynamic instability in other disorders with presumption of reversibility of the condition, eg in acute myocarditis, decompensation of chronic heart failure, or in resistant, hemodynamically severe arrhythmias.
- Sudden cardiac arrest resistant to conventional cardiopulmonary resuscitation. This only applies to patients who have stopped during full monitoring or in front of witnesses, and good indirect indirect massage with minimal perfusion time can be demonstrated. At the same time, these patients will be provided with a method of controlled temperature control. In the case of outpatient circulatory arrest, the indication is governed by a specific protocol.
- Severe hemodynamic instability in cardiotoxic intoxication.
Cardiac surgery indications:
- Post-cardiotomy cardiogenic shock, which occurs either during surgery (impossibility of disconnection from extracorporeal circulation despite maximum pharmacological support and / or IABK support) or develops in the postoperative ward.
- In patients with severe cardiac dysfunction (eg dilated cardiomyopathy), in whom surgery (eg mitral valve reconstruction) to bridge the perioperative period is indicated.
Pediatric and neonatological indications:
- Severe neonatal pneumopathy, persistent neonatal pulmonary hypertension, some congenital malformations (eg diaphragmatic hernia, congenital heart defects, etc.).
- Severe respiratory failure in childhood (eg viral infections, etc.).
- Severe circulatory failure, unmanageable in a conventional manner (eg fulminant myocarditis, septic shock, etc.).
- Intracranial hemorrhage, stroke or hypoxic circulatory arrest are absolute. Furthermore, previously known irreversible damage to the lung parenchyma by chronic disease and secondary infection (eg Covid-19).
- Relative contraindications are age over 65 years, obesity with BMI over 40, IPPV over 7 days, advanced liver disease, trauma accompanied by severe bleeding, hemorrhagic diathesis with thrombocytopenia. The degree of immunocompromise is evaluated by an experienced intensivist individually.
- Indications for VA-ECMO (left-sided, right-sided or congestive heart failure, myocarditis, cardiogenic shock, severe pulmonary hypertension) may be a contraindication to VV-ECMO.