In-depth review of cardiopulmonary support in COVID-19 patients with heart failure

Table 1 Indications and contraindications for Extracorporeal membranous oxygenation in coronavirus disease 2019

Indications for ECMO	Contraindications for ECMO
V-V ECMO; PaO2/FiO2 < 60 mmHg for > 6 h < 50 mmHg for > 3 h; pH < 7.2 with PaCO2 > 80 mmHg for > 6 h	Relative contraindications; Age ≥ 65 yr old; Body mass index ≥ 40; Immunocompromised status; No legal medical decision maker available; Advanced chronic underlying systolic heart failure; High dose vasopressor requirement (and not under consideration for VA or V-VA ECMO); Absolute contraindications; Advanced age; Clinical frailty scale category ≥ 3; Mechanical ventilation > 10 d; Significant comorbidities: Chronic kidney disease ≥ III; Cirrhosis; Dementia; Baseline neurological disease which might prohibit rehabilitation potential; Disseminated malignancy; Advanced lung disease; Uncontrolled diabetes with chronic end-organ dysfunction; Severe deconditioning; Protein-energy malnutrition; Severe peripheral vascular disease; Other preexisting life-limiting medical condition; Nonambulatory or unable to perform activities; Severe multiple organ failure; Severe acute neurologic injury (example: anoxic, stroke); Uncontrolled bleeding; Contraindications to anticoagulation; Inability to accept blood products; Ongoing cardiopulmonary resuscitation
V-A ECMO; Refractory cardiogenic shock; Persistent tissue hypoperfusion; Systolic blood pressure < 90 mmHg; Cardiac index < 2.2 L/min/m2 while receiving noradrenaline > 0.5 mcg/kg/min; Dobutamine > 20 mcq/kg/ min or equivalent

ECMO: Extracorporeal membranous oxygenation; V-V: Veno-venous; V-VA: Veno-Venoarterial; V-A: Veno-arterial.