Schmidt et al identified factors associated with failure in the use of extracorporeal membrane oxygenation (ECMO). Recognition of these conditions can influence the decisions made in patient management. The authors are from Hopital de le Pitie-Salpetriere in Paris.
Predictors for failure in the use of ECMO:
(1) selecting an inappropriate ECMO configuration for the patient (for example, using peripheral venoarterial in a patient with ARDS and preserved cardiac function)
(2) chronic, irreversible cardiopulmonary disease with no hope of recovery or transplant
(3) out-of-hospital cardiac arrest with prolonged low cardiac output
(4) severe aortic regurgitation (associated wit ventricular overloading)
(5) type-A aortic dissection
(6) refractory septic shock in an adult with preserved left ventricular function
(7) allogeneic stem cell transplant (ASCT)
(8) ARDS and advanced age, especially if > 70 years of age
(9) ARDS with multi-organ failure (or elevated SOFA score)
(10) prolonged mechanical ventilation prior to ECMO (>= 7 days)
(11) inexperience with ECMO
