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ECMO (Extracorporeal membrane oxygenation)


ECMO is a very advanced form of life support that is essentially a heart-lung bypass machine. It’s often used during open heart surgery, but can also be used in situations where patients are incredibly hypoxemic. The ECMO machine itself is often referred to as a “circuit”; this circuit delivers blood from the patient through the “ECMO lung” and then back to the patient. It is essnetially like dialysis for the lungs; it addes oxygen and removes carbon dioxide.

There are two types of ECMO:

  • V-V (venovenous) ECMO: no hemodynamic support, purely oxygenation/ventilation; replaces lungs

  • V-A (venoarterial) ECMO: hemodynamic support; replaces heart and lungs

ECMO is only available at PAH or Emory. In order to refer a patient for ECMO, you must call the ECMO team to determine if they are a candidate.

Each ECMO team will have their own guidelines in place so it’s important to call and check for candidacy no matter what. In general, in order to be an ECMO candidate, the general considerations are:

  1. Hypoxic Respiratory Failure due to any cause (primary or secondary) when risk of mortality is>50%

    1. 50% Mortality: P/F ratio<150 on FiO2>90% and/or Murray score 2-3

    2. 80% Mortality: P/F ratio<100 on FiO2>90% and/or Murray score 3-4 despite optimal care for 6+ hours

  2. CO2 retention on mechanical ventilation despite high Pplat (>30cm H2))

  3. Severe Air Leak syndromes

  4. Need for intubation in a patient on lung transplant list

  5. Immediate cardiac or respiratory collapse (PE, blocked airway, unresponsive to optimal care)

There are no absolute contraindications to ECMO. Relative contraindications are:

  1. Intubated at high settings (FiO2>90%, Pplat>30) f0r 7 days or more

  2. Major pharmacologic immunosuppression (abs neutrophil count<400/mm3)

  3. CNS hemorrhage - recent or expanding

  4. Non recoverable co-morbidity such as major CNS damage or terminal malignancy

  5. Age: no specific age contraindication but consider increasing risk w/increasing age

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