Current role of extracorporeal membrane oxygenation for the management of trauma patients: Indications and results

Table 1 Summary of the indications for the use of veno-venous-extracorporeal membrane oxygenation[10,13-15]

No.	Indication
1	Primary 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
2	Acute respiratory distress syndrome
3	Bronchopleural fistulas and pulmonary air leaks
4	Complicated airway management
5	Bacterial/viral/atypical pneumonia
6	Interstitial pneumonitis
7	Airway obstruction
8	Pulmonary 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 resuscitation	Sepsis-associated cardiomyopathy
Post-cardiotomy cardiac failure	Pulmonary 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)
Immunocompromised	Cardiogenic 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 contraindication	Cerebral hemorrhage/cerebral herniation/intractable intracranial hypertension
Central nervous system injury

VV-ECMO: Veno-venous-extracorporeal membrane oxygenation.

Table 4 Contraindications for veno-arterial-extracorporeal membrane oxygenation[9,21-23]

Absolute contraindications	Relative contraindications
Unrecoverable cardiac condition	Contraindication 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 recovery	Aortic regurgitation
Chronic aortic insufficiency (inconsistencies within the literature regarding this contraindication)	Morbid obesity
Incompatibilities with patient’s goal of care	Peripheral vascular disease
	Advanced age (inconsistencies within the literature regarding this contraindication)