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. Mangino
Table
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.
References
- Samuels LE, Kaufman MS, Thomas MP, Holmes EC, Brockman SK, Wechsler AS. Pharmacological criteria for ventricular assist device insertion following postcardiotomy shock: experience with the ABIOMED BVS system. J Card Surg. 1999;14:288–93. DOIPubMedGoogle Scholar
- Thalanany MM, Mugford M, Hibbert C, Cooper NJ, Truesdale A, Robinson S, ; CESAR Trial Group. Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: conventional ventilation or ECMO for severe adult respiratory failure (CESAR). BMC Health Serv Res. 2008;8:94. DOIPubMedGoogle Scholar
- Extracorporeal life support: the University of Michigan experience. JAMA. 2000;283:904–8.Bartlett RHRoloff DWCuster JRYounger JGHirschl RB DOIPubMedGoogle Scholar
- Lefrak EA, Steven PM, Pitha J, Balsinger E, Noon GP, Mayor HD. Extracorporeal membrane oxygenation for fulminary influenza pneumonia. Chest. 1974;66:385–8. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. Intensive-care patients with severe novel influenza A (H1N1) virus infection—Michigan, June 2009. MMWR Morb Mortal Wkly Rep. 2009;58:749–52.PubMedGoogle Scholar
Page created: December 09, 2010
Page updated: December 09, 2010
Page reviewed: December 09, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.