UMEM Educational Pearls

Category: Critical Care

Title: ECMO

Posted: 10/20/2009 by Mike Winters, MD (Updated: 10/23/2020)
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Extracorporeal Membrane Oxygenation

  • 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)

References

Schuerer DJE, Kolovos NS, Boyd KV, Coopersmith CM. Extracorporeal membrane oxygenation: Current clinical practice, coding, and reimbursement. Chest 2008;134:`79-84.