Empleo de ECMO en UCI. Recomendaciones de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias

Candent issues in pneumonia. Reflections from the Fifth Annual Meeting of Spanish Experts 2023

“…Extracorporeal membrane oxygenation (ECMO) . ECMO provides circulatory (venous and/or arterial) and/or respiratory support for a short period of time (days or weeks) in patients with cardiac or respiratory failure refractory to conventional treatments [ 220 ]. Clinicians can indicate ECMO in these settings when all other available treatments fail [ 220 ]: Pneumonia of any aetiology, aspiration syndromes, alveolar proteinosis, obstetric pathology, inhalation syndromes, airway obstruction, pulmonary contusion, bronchopleural fistula, bridge therapy, intraoperative respiratory support, asthmatic status, pulmonary haemorrhage or massive haemoptysis, hypercapnia (pH < 7.20) and/or PaCO 2 > 80 mmHg, inability to maintain plateau pressure < 30 cmH 2 O, pulmonary vasculitis.…”

“…ECMO contraindications in ARDS are [ 220 ]: lung disease without predictable recovery of lung function if lung transplant is not indicated, contraindications for anticoagulation treatment, age > 65 years (more limited evidence). It is a relative contraindication, multiorgan failure with SOFA > 15 points, mechanical ventilation more than 7 days (special consideration with plateau pressure >30 cmH 2 O, impossibility of pressure>10 mmH 2 O, FiO 2 > 0.9).…”

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“…Although it is a live saving procedure for severe ill patients, it is associated with potential lethal complications such as catheter-related bacteraemia (14-44 ‰ catheter days), VAP (20-60‰ days of ventilation), catheter-related urinary tract infection (1-14‰ days of catheterization) and it also affects the pharmacokinetics and pharmacodynamics of some drugs (for example lipophilic drugs) [220,[226][227][228][229][230][231]. In Spain, nosocomial infections were more frequent in patients with COVID-19 pneumonia [226].…”

“…. ECMO provides circulatory (venous and/or arterial) and/or respiratory support for a short period of time (days or weeks) in patients with cardiac or respiratory failure refractory to conventional treatments [220]. Clinicians can indicate ECMO in these settings when all other available treatments fail [220]: Pneumonia of any aetiology, aspiration syndromes, alveolar proteinosis, obstetric pathology, inhalation syndromes, airway obstruction, pulmonary contusion, bronchopleural fistula, bridge therapy, intraoperative respiratory support, asthmatic status, pulmonary haemorrhage or massive haemoptysis, hypercapnia (pH < 7.20) and/or PaCO 2 > 80 mmHg, inability to maintain plateau pressure < 30 cmH 2 O, pulmonary vasculitis.…”

“…ECMO contraindications in ARDS are [220]: lung disease without predictable recovery of lung function if lung transplant is not indicated, contraindications for anticoagulation treatment, age > 65 years (more limited evidence). It is a relative contraindication, multiorgan failure with SOFA > 15 4.…”