Contraindications to extracorporeal membrane oxygenation

Absolute

Severe irreversible noncardiac organ failure or condition limiting survival (eg, severe anoxic brain injury, end-stage malignancy)

No transition to a well-defined end point (eg, recovery, transplantation, assist device; "a bridge to nowhere")

Severe aortic insufficiency*

Aortic dissection*

Relative

Severe coagulopathy or contraindication to anticoagulation

Limited vascular access*

Severe PAD*

Advanced age^¶

Morbid obesity^¶

Severe immunocompromised status

Advanced comorbid conditions that would otherwise limit recovery

Prolonged duration of mechanical ventilation (eg, ≥7 days)^Δ

Lack of resources to support ECMO-associated care

ECMO: extracorporeal membrane oxygenation; V-A: venoarterial; PAD: peripheral arterial disease; V-V: venovenous.

* Applies to V-A ECMO.

¶ Cutoff points vary by individual patient characteristics and are usually institution specific.

Δ Applies to V-V ECMO.

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