Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ −2 points, PRESET score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.
Highlights
The use of veno-venous extracorporeal membrane oxygenation has gained worldwide acceptance and is today recommended in international guidelines [1,2] as a salvage therapy in patients with severe acute respiratory failure, when conservative measures are unsuccessful
(3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score ≤ −2 points, Prediction of Survival on ECMO Therapy (PRESET) score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status)
From our literature review, we found that, in patients treated with Extracorporeal membrane oxygenation (ECMO) for severe ARDS, mortality decreased, while, in many trials, body mass index (BMI) increased (Table 8)
Summary
The use of veno-venous extracorporeal membrane oxygenation (vvECMO) has gained worldwide acceptance and is today recommended in international guidelines [1,2] as a salvage therapy in patients with severe acute respiratory failure, when conservative measures are unsuccessful. A meta-analysis of individual patient data from two of the aforementioned studies demonstrated a survival advantage in the group of patients treated with ECMO [6]. These studies have obviously led physicians to using this technique earlier [7], and the number of extracorporeal techniques used worldwide is subsequently increasing [8,9]. With the technical issues largely resolved and increasing experience in clinical management, the biggest challenge today is selecting the right candidates for vvECMO, i.e., those who will benefit most from this invasive treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
