This document outlines indications and contraindications for extracorporeal membrane oxygenation (ECMO). Key indications include hypoxemic and hypercapnic respiratory failure, as a bridge to lung transplantation, cardiac/circulatory failure including right ventricular failure, massive pulmonary embolism, and cardiac arrest. Specific conditions listed include severe pneumonia, acute respiratory distress syndrome, and pulmonary edema. Absolute contraindications are severe neurologic injury and end-stage malignancy, while relative contraindications include uncontrollable bleeding and very poor prognosis from the underlying condition.

2. INDICATIONS
• Hypoxemic respiratory failure
• Hypercapnic respiratory failure
• Ventilatory support as a bridge to lung transplantation.
• Cardiac/circulatory failure/refractory cardiogenic shock including right
ventricular failure
• Massive pulmonary embolism.
• Cardiac arrest
• Failure to wean from cardiopulmonary bypass after cardiac surgery
• As a bridge to either cardiac or lung transplantation or placement of a
ventricular assist device

3. Hypoxemic respiratory failure and
Hypercapnic respiratory failure
• Severe Pnemonia
• ARDS
• Acute Graft rejection after transplant
• Pulmonary contusions
• Refractory status asthamatics
• Smoke inhalation
• Alveolar proteinosis
• Airway Obstuction
• Aspiration Syndromes

4. Hypoxemic respiratory failure
• CESAR -
• EARLY than Rescue therapy
• <18 years or >65 years,
intubation greater than
seven days
• severe acute respiratory
failure as hypercapnic
respiratory acidosis with an
arterial pH <7.20 or a
Murray score greater than
3.0
INDICATIONS
EOLIA
ECMO to rescue lung injury
in severe ARDS
PaO2:FiO2] <50 mmHg >3
hours or PaO2:FiO2 <80
mmHg for >6 hours)

5. SCORE > 3

6. Cardiac/circulatory failure/refractory cardiogenic shock
• Post Cardiac surgery unable to wean from CPB
• Cardiomyopathy bridge to transplant or Ventricular assist devices
• Ishaemic cardiogenic shock
• Non ischaemic Cardiogenic shock - Acute fulminant myocarditis
• Drug overdose induced cardiac depression - Beta blockers, CCB
• Sepsis Induced myocardial depression
• Post Transplant Graft failure - Heart or lung

7. Contraindications
Absolute contraindication to
ECMO is a pre-existing
condition that is Incompatible
with recovery
1. Severe neurologic injury
2. End stage malignancy
Relative contraindications
1. Uncontrollable bleeding
2. Very poor prognosis from
the primary condition
3. Results in respiratory
failure are better when
ECMO is instituted within
seven days of intubation
4. High risk of death
despite optimization of
medical treatment