Volume 15, Number 12—December 2009
Letter
Extracorporeal Membrane Oxygenation for Pandemic (H1N1) 2009
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.
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