Indications for ECMO in ARDS

Experience gained in the 2009 flu pandemic has refined our approach to the use of ECMO. Recommendations form a consensus conference have recently been published. Here is a summary of the indications, form the document:

2.1 Use of VV ECMO should be considered if the PaO2/FiO2 ratio is below 50 mmHg when FiO2 = 1 for at least three hours, despite a protective ventilation strategy (involving use of prone positioning) (CR).

2.2 Use of VV ECMO should be discussed if the PaO2/FiO2 ratio is below 80 mmHg when FiO2 = 1 for more than six hours, despite a protective ventilation strategy (involving use of prone positioning) (CR).

2.3 Use of VV ECMO should be discussed if, associated with a protective ventilation strategy (involving use of prone positioning), there is respiratory acidosis with a pH less than 7.20 for over six hours (CR).

2.4 There is no indication for VA ECMO in ARDS when respiratory failure is isolated. VA ECMO can be considered if there is concurrent cardiogenic shock (CR).

2.5 When acute cor pulmonale prompts use of ECMO, it is not a mandatory indication for VA ECMO (CR).

Concerning extra-corporeal CO2 removal (ECCO2R), the authors said it could not be recommended at this time pending further study.