Adult Referrals
Selection of patients with respiratory failure for ECLS:
Inclusion criteria
Hypoxemic respiratory failure
- Failure of mechanical ventilation (PC-IRV) to reverse hypoxemia and improve lung compliance
- Diffusely abnormal chest radiograph
- Transpulmonary shunt > 30% on FiO2 > 0.6
- Total static lung compliance < 0.5 ml/cm H2O/kg(or < 30 ml/cm H2O at Vt 10 ml/kg)
- Lack of PEEP recruitment response (PEEP 5-->15 cm H2O)
Hypercarbic respiratory failure
- Uncorrectable hypercarbia with pH < 7 and PIP > 45, or
- PaCO2 > 45 despite Ve > 200 ml/kg/min
Selection of patients with respiratory failure for ECLS:
Exclusion criteria
Absolute
- Contraindication to systemic anticoagulation (except surface-coated systems)
- Terminal disease with short expected survival
- Underlying moderate to severe chronic lung disease
- Advanced multiple organ failure syndrome
- Unresponsive septic shock
- Uncontrolled metabolic acidosis
- Central nervous system injury
- Severe immunosuppression
Relative: venovenous ECLS
- Mechanical ventilation > 7 days
- Myocardial dysfunction (CI < 3.5) on inotropic therapy
- Severe pulmonary hypertension (MPAP > 45 or > 75% systemic)
- Cardiac arrest
- Age > 60 years
Relative: venoarterial ECLS
- Mechanical ventilation > 7 days
- Irreversible or chronic cause of cardiac dysfunction
- Age > 60 years
Further discussion of of the above criteria can be found in Selection Criteria for Use of ECLS in Adults.
For Adult referrals please call 1-734-936-6626, pager # 9766, or contact M-Line or the UM Transfer Center
