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Copyright ©The Author(s) 2025.
World J Crit Care Med. Mar 9, 2025; 14(1): 96694
Published online Mar 9, 2025. doi: 10.5492/wjccm.v14.i1.96694
Table 1 Summary of the indications for the use of veno-venous-extracorporeal membrane oxygenation[10,13-15]
No.
Indication
1Primary indication: Severe, acute respiratory failure refractory to conventional respiratory and medical therapy; including one or more of hypoxemic respiratory failure, hypercapnic respiratory failure, and ventilation support for those awaiting lung transplantation or those dealing with primary graft dysfunction after lung transplantation
2Acute respiratory distress syndrome
3Bronchopleural fistulas and pulmonary air leaks
4Complicated airway management
5Bacterial/viral/atypical pneumonia
6Interstitial pneumonitis
7Airway obstruction
8Pulmonary hemorrhage
Table 2 Common indications for veno-arterial-extracorporeal membrane oxygenation use[9,18-21]
Generally accepted indications
Indications under consideration
Cardiogenic shock (due to, e.g., acute myocardial infarction, heart failure, fulminant myocarditis, etc)Massive pulmonary embolism
Cardiac arrest in the setting of extracorporeal cardiopulmonary resuscitationSepsis-associated cardiomyopathy
Post-cardiotomy cardiac failurePulmonary hypertension
Bridging therapy tool
Table 3 Contraindications for the use of veno-venous-extracorporeal membrane oxygenation[10,13,14,16,17]
Relative contraindications
Absolute contraindications
Advanced age (typically > 70 years of age)Non-recovery anticipation with no plan for viable de-cannulation (possibly due to multi-organ failure)
ImmunocompromisedCardiogenic failure (vital in VV-ECMO)
Ventilation of patients for an extended period (typically > 7 days)Patient compliance and autonomy
BMI (differs from center to center)Disseminated advanced-stage malignancy
Anticoagulation contraindicationCerebral hemorrhage/cerebral herniation/intractable intracranial hypertension
Central nervous system injury
Table 4 Contraindications for veno-arterial-extracorporeal membrane oxygenation[9,21-23]
Absolute contraindications
Relative contraindications
Unrecoverable cardiac conditionContraindication to anticoagulation
Short life expectancy (generally less than 1 year)Aortic dissection
Preexisting conditions with significant mortality rates and/or those that are incompatible with adequate recoveryAortic regurgitation
Chronic aortic insufficiency (inconsistencies within the literature regarding this contraindication)Morbid obesity
Incompatibilities with patient’s goal of carePeripheral vascular disease
Advanced age (inconsistencies within the literature regarding this contraindication)