Published in:
01-05-2016 | What's New in Intensive Care
Ten situations in which ECMO is unlikely to be successful
Authors:
Matthieu Schmidt, Nicolas Bréchot, Alain Combes
Published in:
Intensive Care Medicine
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Issue 5/2016
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Excerpt
Extracorporeal membrane oxygenation (ECMO) used for respiratory or cardiac support is frequently considered a rescue therapy when “conventional” management fails. Although the prognoses of these patients have steadily improved over the last decade, the technique is still marred by high mortality (30–70 %). Moreover, ECMO is expensive—in supplies, human resources, and time—which encourages restraining its use for patients who are more likely to survive. Efforts have recently been made to identify the main risk factors associated with ECMO failure for both acute respiratory distress syndrome (ARDS) (Table
1) and refractory cardiogenic shock. We describe below ten situations in which ECMO is unlikely to be successful.
Table 1
Main pre-ECMO risk factors of in-hospital mortality for severe ARDS
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Increasing SOFA score [ 8, 13]
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Immunocompromised status [ 6‐ 8, 13]
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≥7 days of mechanical ventilation [ 7, 8]
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Elevated plateau pressure [ 7, 8]
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Multiorgan dysfunctions [ 6, 7]
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