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Volume 15, Number 12—December 2009


Extracorporeal Membrane Oxygenation for Pandemic (H1N1) 2009

Michael S. FirstenbergComments to Author , Danielle Blais, Louis B. Louis, Kurt B. Stevenson, Benjamin Sun, and Julie E. Mangino
Author affiliations: Ohio State University Medical Center, Columbus, Ohio, USA

Main Article


Relative indications and contraindications for extracorporeal membrane oxygenation*

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)
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.

Main Article