The neonate should be at least 35 weeks of gestation (a lower age is a contraindication).
Indications - all 3 of the following:
(1) one or more of the following:
(1a) persistent severe hypoxia
(1b) persistent acidosis, with pH < 7.20 despite alkalinization therapy, bicarbonate infusions and/or hyperventilation
(1c) barotrauma
(1d) cardiac dysfunction in the absence of major congenital heart disease
(2) failure of maximal medical treatment
(3) high risk for imminent mortality
where:
• The underlying dysfunction should be reversible. This probably underlies the exclusion of major congenital heart disease.
Manifestations of severe hypoxia may include:
(1) oxygenation index > 40
(2) A-a DO2 > 400 mm Hg
(3) PaO2 < 50 mm Hg while on ventilator with PIP > 35 or mean airway pressure > 20 cm H2O
ECMO should not be used if the infant shows one or more contraindications.
