Case of the Month #11 - VV ECMO

Published 02/02/2022

What are the indications for VV ECMO?

In patients with life threatening hypoaexmia or hypercapnia despite optimal mechanical ventilation extracorporeal support should be considered and discussed early. In the UK the provision of VV ECMO is delivered through a national severe respiratory failure network.

The general indications, as per the CESAR trial, are as follows:

  1. Lung Injury Score>3 (includes PF ratio, consolidation on CXR, PEEP and compliance)
  2. Uncompensated hypercapnia with pH<7.20
  3. Reversible pathology
  4. No underlying life limiting co-morbidity leading to dependency on ECMO

Patients must have failed optimal conventional management, including trials of prone ventilation, when advised by the accepting centre.

During the coronavirus pandemic, in the absence of previous disease specific data, referral criteria were more explicit to standardise referral and triage. The criteria were revised to include clinical frailty score and RESP score (a VV ECMO survival prediction score).