Indications for ECMO

Exploration for rescue modalities of treatment when the gas exchange was not possible, especially after all measures of conventional management have failed, has been on for the past couple of centuries. Intensified research and consolidation of thoughts have led to designing machinery and tools such as oxygenators for carrying out gas exchange. Since the invention of heart-lung machine by Dr. Gibbon 70 years ago, along with further evolution in the structure of the membrane oxygenator, anticoagulation policies and ECMO strategies improved over time. Understanding the indications and contraindications for ECMO is crucial to select the patients who are likely to benefit from ECMO after failure of maximal conventional management. With the experience gained from published literature and randomized controlled trials, we understand the best period to go onto ECMO, factors which are likely to impact adverse outcomes, and various scores and indices worked out as objective indicators for identifying the patients with need for going onto ECMO. We also understand the contraindications when you do not want to put patients on ECMO as the effects could be detrimental. Despite the consideration of the objective criteria, the physician’s viewpoint based on the rapidity of deterioration of patient’s clinical status on conventional management, thus choosing ECMO for stabilization, should not be underestimated.