Table 1 Indications and contraindications for VV ECMO

Indications

Endotracheal intubation and mechanical ventilation < 7 days

Hypoxic respiratory failure due to any cause when the predicted mortality risk is > 80%:

 - PaO₂/FiO₂ ≤ 50 mmHg for > 3 h

 - PaO₂/FiO₂ ≤ 80 mmHg for > 6 h

 - Arterial blood pH of < 7.25 with a PaCO₂ ≥ 60 mmHg for > 6 h, with the RR increased to 35 bpm)

[Mechanical ventilation settings adjusted to keep a P_plat ≤ 32 cmH₂O despite ventilator optimization

(FiO₂ ≥ 0.80, a VT 6 ml/Kg of PBW and a PEEP ≥ 10 cmH₂O)]

Severe air leak syndrome

Need for intubation in patients on lung transplant list

Absolute contraindications

Irreversible lung disease

Relative contraindications

Age ≥ 65–70 y

Immunocompromised status

No legal medical decision-maker available

Advanced chronic systolic heart failure

Clinical Frailty Scale Category ≥ 3

Significant comorbidities

- CKD ≥ III

- Cirrhosis

- Dementia

- Baseline neurologic disease precluding rehabilitation potential

- Uncontrolled diabetes with chronic end-organ dysfunction

- Severe deconditioning

- Protein-energy malnutrition

- Severe peripheral vascular disease

- Other life-limiting medical illness

- Non-ambulatory status

Severe multiple organ failure

Severe acute neurologic injury, e.g., anoxic, stroke

Uncontrolled bleeding or contraindication to anticoagulation

Inability to accept blood products

Ongoing CPR