Contraindications to ECMO

Relative contraindications to ECMO at the Center for Acute Respiratory Failure at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center include:

• High pressure ventilation or high FIO₂ requirements for more than 7 days
• Limited vascular access
• Inability to accept blood products
• Severe coagulopathy
• Any condition or organ dysfunction that would limit the likelihood of overall benefit from ECMO, such as severe, irreversible brain injury or untreatable metastatic cancer

Relative contraindications for VA ECMO include:

• Severe irreversible non‐cardiac organ failure limiting survival (i.e., severe anoxic brain injury)
• Irreversible cardiac failure if transplantation or long‐term ventricular assist device (VAD) will not be considered
• Severe aortic insufficiency
• Aortic dissection

VA-ECMO is not intended for patients with a low likelihood of myocardial recovery or who are not candidates for durable VAD or cardiac transplant given the lack of an exit strategy.