ECMO

Refer a Patient

To refer a patient for possible ECMO support:
Call the Transfer Center 24 hours a day at 1-800-520-7575 and say you would like to refer a patient for ECMO.
If possible, call prior to cannulation to discuss your patient.

Currently serving: Alaska, Idaho, Montana, Oregon, Washington, and Wyoming.

Information to have ready prior to call

Please have the following information ready for the conference call with the ECMO physician at UW Medicine:

    1. Height & weight: ***
    2. Brief history of present illness and diagnosis: ***
    3. Relevant past medical history: ***
    4. Last vital signs: Heart Rate (pacer?) ***, Blood Pressure ***, SpO2 ***
    5. Last ABG: pH*** PaCO2 *** PaO2: *** HCO3: *** (on *** FiO2)
    6. Ventilator settings:  Rate ***, Tidal volume or inspiratory pressure ***, FiO2% ***, PEEP ***, plateau pressure (if on volume control) ***
    7. Duration of plateau pressures > 30 (days? hours?): ***
    8. ARDS therapies: Prone Y/N, Paralytics Y/N, Inhaled vasodilators Y/N, esophageal balloon Y/N
    9. Vasoactive medications and doses: ***
    10. Other infusions running: ***
    11. Non-pulmonary organ failure/injury (kidney, liver, brain)? ***
    12. Last neurologic exam? ***
    13. Bleeding/ coagulopathy? Y/N
    14. Recent cardiac arrest? Y/N
    15. Results of echocardiogram: ***
    16. Current lines, tubes, and drains: ***

UW Medicine Indications and Contraindications for ECMO

VA ECMO

Indications for VA ECMO support

  1. Cardiogenic shock (ie. ACS, myocarditis, acute decompensated heart failure)
  2. Advanced respiratory failure with associated circulatory failure
  3. Massive pulmonary embolism
  4. Post-cardiotomy failure
  5. Primary cardiac allograft dysfunction
  6. Peri-procedural support

Absolute Contraindications – VA ECMO

  1. Acute aortic dissection
  2. Advanced cancer
  3. Significant irreversible neurological injury
  4. Chronic end-stage renal disease on dialysis

Relative Contraindications – VA ECMO

  1. Irreversible heart failure ineligible for transplant, durable VAD, or total artificial heart (TAH)
  2. Irreversible acute multi-organ failure with high probability of death whether or not ECMO is utilized
  3. Pulmonary hypertension not secondary to left heart disease.
  4. Advanced age >75 years
  5. Severe coagulopathy
  6. Refractory vasoplegic shock without low cardiac output state
  7. Cardiac arrest with CPR >60 min prior to commencement of ECMO

VV ECMO

Indications for VV ECMO support

  1. Severe acute hypoxemic respiratory failure/ARDS (P/F <100) despite optimal conventional medical therapy
  2. Severe reversible hypercarbic respiratory failure (pH <7.2)
  3. Acute respiratory failure in patients actively listed for lung transplantation
  4. Severe primary graft dysfunction following lung transplantation

Absolute Contraindications – VV ECMO

  1. Advanced cancer
  2. Significant irreversible neurological injury

Relative Contraindications – VV ECMO

  1. ARDS with prolonged high level mechanical ventilatory support (>7-10 days)*

    2. *We encourage early referral of ECMO support for respiratory failure not responding to optimal medical therapy

  2. Irreversible pulmonary failure ineligible for transplant (patients with chronic lung disease must be listed for transplant prior to ECMOinitiation if plan is for bridge to lung transplant)
  3. Irreversible acute multi-organ failure with high probability of death whether or not ECMO is utilized
  4. Severe pulmonary hypertension
  5. Advanced age >75 years
  6. Severe coagulopathy
  7. Cardiogenic or obstructive shock (consider VA ECMO) or refractory septic shock

 

Transport Instructions Checklist

We’ve created a helpful checklist for referring hospitals

View Printable Checklist