Indications for ECMO

Acute Respiratory Distress Syndrome

• Severe hypoxemia with a ratio of PaO₂ to FIO₂ less than 80 despite the application of high levels of PEEP and salvage therapies, as appropriate for at least 6 hours.
• ECMO may be considered after a shorter time interval if the ratio of PaO2 to FIO2 is less than 50.
• Uncompensated hypercapnia or excessively high plateau airway pressures, despite the best accepted standard of care for management with a ventilator

Hypercapnic Respiratory Failure

• Hypercapnic respiratory failure due to acute exacerbation of asthma, COPD, or other chronic lung disease as a bridge-to-recovery may be considered on a case-by-case basis.

Lung Transplant Candidates

• Patients listed for lung transplantation at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center may be placed on ECMO, when necessary, as a bridge-to-transplant.

Cardiac Indications

• Patients with cardiogenic shock with underlying etiologies that include:
  • Primary ischemic etiologies such as acute myocardial infarction
  • Non-ischemic etiologies including fulminant myocarditis, peripartum cardiomyopathy, decompensated pulmonary hypertension
• Primary graft failure following cardiac transplant
• Patients with massive pulmonary embolism as a bridge to more definitive therapy
• In selected cases, VA-ECMO with advanced cardiac life support is initiated emergently to restore circulation during cardiac arrest in addition, a use known as extracorporeal CPR (E-CPR).