Extracorporeal Life Support

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Selection of patients with respiratory failure for ECLS:

Inclusion criteria

Hypoxemic respiratory failure
  • Failure of mechanical ventilation (PC-IRV) to reverse hypoxemia and improve lung compliance
  • Diffusely abnormal chest radiograph
  • Transpulmonary shunt > 30% on FiO2 > 0.6
  • Total static lung compliance < 0.5 ml/cm H2O/kg(or < 30 ml/cm H2O at Vt 10 ml/kg)
  • Lack of PEEP recruitment response (PEEP 5-->15 cm H2O)
Hypercarbic respiratory failure
  • Uncorrectable hypercarbia with pH < 7 and PIP > 45, or
  • PaCO2 > 45 despite Ve > 200 ml/kg/min

Selection of patients with respiratory failure for ECLS:

Exclusion criteria

  • Contraindication to systemic anticoagulation (except surface-coated systems)
  • Terminal disease with short expected survival
  • Underlying moderate to severe chronic lung disease
  • Advanced multiple organ failure syndrome
  • Unresponsive septic shock
  • Uncontrolled metabolic acidosis
  • Central nervous system injury
  • Severe immunosuppression
Relative: venovenous ECLS
  • Mechanical ventilation > 7 days
  • Myocardial dysfunction (CI < 3.5) on inotropic therapy
  • Severe pulmonary hypertension (MPAP > 45 or > 75% systemic)
  • Cardiac arrest
  • Age > 60 years
Relative: venoarterial ECLS
  • Mechanical ventilation > 7 days
  • Irreversible or chronic cause of cardiac dysfunction
  • Age > 60 years

Further discussion of of the above criteria can be found in Selection Criteria for Use of ECLS in Adults.

For Adult referrals please call 1-734-936-6626, pager # 9766, or contact M-Line or the UM Transfer Center.

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