We welcome discussions about any patient with potentially reversible severe acute respiratory failure. Our ECMO service can offer advice, imaging reviews, thoracic surgical input, high frequency oscillation, and extracorporeal carbon dioxide removal and ECMO, tailored according to the requirements of the patient and referring centre.
Typical patients will include those with reversible disease associated with one or more of:
- Severe hypoxaemia (e.g. PaO2/FiO2 < 13.3kPa)
- Severe hypercapnic acidosis (e.g. pH<7.20)
- Inability to achieve lung protective tidal volumes and pressures (tidal volume < 6 mL/Kg predicted body weight, plateau pressure < 30 cmH2O)
- Failure to improve with rescue therapies such as high frequency oscillation and prone positioning
- Significant air leak/bronchopleural fistula
Eligibility criteria for consideration of ECMO
There are specific criteria for consideration of ECMO support. These are based on the CESAR study and defined by NHS Specialised Services during the commissioning of ECMO capacity.
Indications:
- Age ≥16 years
- Potentially reversible severe acute respiratory failure
- No limitation to on-going life-sustaining treatment
- Murray score ≥3.0 (consider referral if ≥2.5 and rapid clinical deterioration) OR
- Uncompensated hypercapnoea with pH <7.20
Contraindications:
- Intracranial bleed (current or recent)
- Other contraindication to heparinisation
- High pressure (peak inspiratory pressure >30 cmH2O) and/or high FiO2 (>0.8) ventilation for more than 7 days (relative contraindication)
- Age >65 years (relative contraindication)
Murray score
|
|
0
|
1
|
2
|
3
|
4
|
|
P/F ratio (kPa)
|
≥40
|
30-39.9
|
23.3 – 29.9
|
13.3 – 23.2
|
<13.3
|
|
PEEP (cmH2O)
|
≤5
|
6-8
|
9-11
|
11-14
|
≥15
|
|
Compliance (ml/cmH2O)
|
≥80
|
60-79
|
40-59
|
20-39
|
≤19
|
|
CXR quadrants infiltrated
|
0
|
1
|
2
|
3
|
4
|
Compliance is calculated as
