Volume 15, Number 12—December 2009
Letter
Extracorporeal Membrane Oxygenation for Pandemic (H1N1) 2009
Michael S. Firstenberg
, Danielle Blais, Louis B. Louis, Kurt B. Stevenson, Benjamin Sun, and Julie E. Mangino
, Danielle Blais, Louis B. Louis, Kurt B. Stevenson, Benjamin Sun, and Julie E. ManginoTable
Relative indications and contraindications for extracorporeal membrane oxygenation*
| Characteristics |
|---|
| Cardiac support (1) |
| Cardiac index <2.2 L/min/m2 |
| Systolic pressure <90 mm Hg |
| Pulmonary capillary wedge pressure >20 mm Hg |
| Central venous pressure >20 mm Hg |
| Two high-dose inotropic medications (Including intraaortic counter pulsation) |
| Respiratory support (2) |
| Murray score >3.0 based on: |
| PaO2/FiO2 ratio |
| No. infiltrated quadrants on chest radiograph |
| Positive end-expiratory pressure requirement |
| Pulmonary compliance |
| Uncompensated hypercapnea (pH<7.2) |
| Contraindications |
| Advancing age (>70 y) |
| Prolonged mechanical ventilation (>7 d) |
| Surgically correctable causes |
| Pneumothorax, effusions, endoluminal obstructions |
| Intracardiac shunts, valvular pathology, incomplete revascularization |
| Medical problems incompatible with prolonged survival |
| Advanced malignancies |
| Contraindications to anticoagulation |
| Irreversible neurologic dysfunction (dementia, stroke, hemorrhage) |
| Medical futility (i.e., prolonged CPR, multiorgan failure) |
*CPR, cardiopulmonary resuscitation; PaO2, partial pressure of oxygen in arterial blood; F1O2, concentration of inspired oxygen.
