Contraindications and Considerations for ECMO

Patient Selection

The American Thoracic Society recommends that ECMO be considered for patients with severe and refractory hypoxemic respiratory failure, with a SOFA score > 15 associated with high mortality 2, 3
The Society of Critical Care Medicine suggests that patients with irreversible brain damage or severe intracranial hemorrhage should not be considered for ECMO, as the risk of mortality is high 1
Patients with advanced cancer or severe multi-organ dysfunction may not benefit from ECMO, as the prognosis is generally poor 2, 3

The Extracorporeal Life Support Organization recommends that ECMO be performed in centers with a minimum volume of 20-25 cases per year, as high-volume centers have better outcomes 2, 3
A multidisciplinary team, including physicians, nurses, perfusionists, and ECMO specialists, should be available 24/7 to manage ECMO patients 2, 3
A nurse-to-patient ratio of 1:1 to 1:2 is recommended to ensure adequate surveillance and care 2, 3

The risk of bleeding complications, including intracranial hemorrhage, is high in ECMO patients, with up to 6% of patients experiencing intracranial hemorrhage 1
Thrombotic events, including stroke and myocardial infarction, can also occur in ECMO patients, with up to 42% of patients experiencing thrombotic events 2, 3
Acquired von Willebrand syndrome (AVWS) can develop in nearly all ECMO patients, contributing to bleeding complications 2, 3

The decision to initiate ECMO should be made after careful consideration of the patient's underlying condition, including the potential for recovery and the presence of contraindications 2, 3
Conventional therapies, including mechanical ventilation and pharmacological interventions, should be optimized before considering ECMO 2, 3
The use of ECMO as a "rescue" therapy after prolonged mechanical ventilation (> 7-9.6 days) is not recommended, as outcomes are generally poor 2, 3