In last week's pearl pertaining to critically ill patients with H1N1, I mentioned the use of ECMO as a potentially life-sustaining treatment for refractory respiratory failure.
Essentially, ECMO removes blood from the patient and circulates it through an artificial lung with a pump. For patients with respiratory failure, this is usually accomplished via cannulation of the femoral and internal jugular veins.
General guidelines to consider ECMO in severe, refractory respiratory failure include:
PaO2 / FiO2 ratio < 100 on 100% FiO2 or A-a gradient > 600 mm Hg
Age < 65 years
No known contraindication to anticoagulation
Lack of significant co-morbidities (due to prolonged recovery after weaning from ECMO)
Schuerer DJE, Kolovos NS, Boyd KV, Coopersmith CM. Extracorporeal membrane oxygenation: Current clinical practice, coding, and reimbursement. Chest 2008;134:`79-84.