Neonates
Neonates requiring ECMO treatment need to meet the following criteria:
Inclusion Criteria
• Oxygenation Index * (OI) >40
• Gestational age >35 weeks
• Weight >2kgs
• Reversible lung disease
* OI = (Mean Airway Pressure [cmH20] x FiO2 [in percentage]) divided by (post ductal PaO2 [mmHg])
Exclusion Criteria
• Significant coagulopathy or uncontrollable bleeding
• Major (>grade 1) intracranial haemorrhage
• Irreversible lung injury
• Major congenital / chromosomal anomalies or severe encephalopathy
• Major cardiac malformation
• Mechanical ventilation 10 - 12 days
• Cardiac arrest other than immediately at birth
Paediatrics
Paediatrics requiring ECMO treatment need to meet the following criteria:
Inclusion Criteria
• Potentially reversible disease
• Failure to respond to maximal treatment
Exclusion Criteria
• Irreversible CNS injury
• Major co-morbidities likely to have significant impact on quality or quantity of life
Adults
The Glenfield Hospital referral process meets the national standards for adult ECMO and includes, but is not limited to, accepting patients who:
• Are critically ill and already receiving lung protective mechanical ventilation
• Have potentially reversible severe respiratory failure and who have failed optimal intensive care management and meet the eligibility criteria for respiratory ECMO; these will be based on the CESAR trial criteria (see guidelines)
Advice should be obtained sooner rather than later. The potential survival benefits of ECMO as a lung protective strategy diminish sharply after one week of conventional ventilation at high pressure and high inspired oxygen concentration.
