Table 1 Criteria for the use of extracorporeal membrane oxygenation (ECMO).

Respiratory failure

1- Treatable underlying respiratory condition

2- Absence of contraindications

• Severe chronic liver disease

• Severe brain injury

• Non-responsive malignancy

3- Requirements for unsafe ventilation to achieve SaO₂ > 88% or pH > 7.20

• Plateau pressure > 35 cmH ₂ O

• Tidal volume > 6 ml/Kg predicted body weight (PBW)

4- With hypoxaemia (SaO2 < 88%) despite

• FiO2 ≥ 90%

• Trial of high positive end-expiratory pressure (between 18 and 22 cmH ₂ O)

• Trial of recruitment manoeuvre (if not contraindicated)

• 2-12 hour trial of inhaled nitric oxide (NO) if available

• Adequate cardiac support (echocardiography assessment, inotropes, pulmonary vasodilators)

5- Or requirement for inter-hospital transport

6- Rate of lung injury progression*

Cardiac failure

1. Diagnosis of cardiogenic shock:

• Echocardiography examination to confirm the presence and nature of cardiac dysfunction and exclude correctible problems

2. Cardiac index and blood pressure inadequate for organ support despite

• Moderate- or high-dose inotropes (adrenaline > 0.3 μg/Kg/min equivalent) in combination with an intra-aortic balloon pump (IABP), vasopressors and positive pressure ventilation for predominately left ventricular failure

• Moderate- or high-dose inotropes (adrenaline > 0.3 μg/Kg/min equivalent) in combination with pulmonary artery vasodilator and/or vasopressors for predominately right ventricular failure

3. Inadequate organ support despite medical therapy as evidenced by

• Onset of hepatic (acute transaminitis), renal (anuria or rising creatinine) dysfunction or skin hypoperfusion (mottled or purpuric)

• Lactate > 4 mmol/L

4. Malignant arrhythmia: refractory ventricular fibrillation or tachycardia not otherwise controlled