Welcome to the official website of Team ECMO ASIA

WHEN IS ECMO INDICATED


ECMO is not usually the first line therapy. It needs to be considered when first line modalities start failing or start causing unwanted effects. A patient deteriorating even after best of mechanical ventilatory efforts for the lungs OR after highest possible doses of inotropes/vasopressors, needs to be considered for ECMO provided the organ failure has a reversible cause.

The choice for the type of ECMO is determined by the predominant failure: V-A ECMO if cardiac and V-V ECMO if respiratory.

The following principles need to be thought out before accepting a patient for ECMO:

• Is the pulmonary/cardiac disease life threatening?

• Is the disease likely reversible?

• Are other diseases relative to prognosis?

• Is ECMO more likely to help than hurt?

• VA or VV?


INDICATIONS OF V-V ECMO

Lung disease that is:

  • Acute .
  • Life threatening
  • Reversible
  • Unresponsive to conventional /alternative therapy

For Example:

1. ARDS

2. Pneumonia

3. Trauma

4. Status asthmaticus

5. Severe COPD exacerbations

6. Trauma/Drowning/lnhalational injuries

7. Auto immune diseases

8. Broncho-pleural fistulas/Post-operative

WHEN DOES A RESPIRATORY FAILURE BECOMES AN ECMO CANDIDATE

If 2 or more of the following criteria’s exist even after four-six hours of maximal conventional ventilation in a reversible disease.

1. Pa02/Fi02 ratio < 100 with Fi02 1.0

2. Murray score > 3

3. Respiratory acidosis pH < 7.2 or PaCO2 > 100

4. A-a gradient > 600mm Hg

5. Lung compliance < 0.5 ml/cm of H20/Kg

INDICATIONS OF V-A ECMO

Acute reversible cardiac failures like

1. Failure to wean from bypass

2. Myocarditis: toxic (aluminium phosphide, beta blockers, CCB) orviral

3. Cardiogenic Shock: Acute MI and its complications

4. Pulmonary embolism

5. Sepsis with profound cardiac depression

6. Trauma

WHEN DOES A CARDIAC FAILURE BECOMES AN ECMO CANDIDATE?

If 2 or more of the following criteria’s exist even after four-six hours of maximal conventional support in a reversible disease

1. Cardiogenic shock on high vasopressors (>=0.2mcg/kg/min of noradrenaline or equivalent vasopressors)

2. Lactate> 5 mmol/L

3. ScV02 < 65%

4. Low cardiac output with Organ failure: AKI, Hepatic, pulmonary edema)

5. Life threatening arrhythmias unresponsive to medical therapy