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ECMO Selection Criteria

The need to escalate to ECMO support can be a difficult decision for a referring physician. Arkansas Children’s Hospital has developed selection criteria to help guide you through this process. The decision to transfer to an ECMO center begins with early consultation to allow for logistics for transport. We hope the following information will help answer some of the questions your team may have. For an ECMO transport call 1-800-ACH-HELP.

Neonatal ECMO

  • Birth weight > 1.8 kg
  • Gestational age > 34 weeks
  • No major bleeding problems
  • Less than 10 days mechanical ventilation
  • Normal head ultrasound of if IVH present it must not be > than grade 1 hemorrhage.
  • No coagulothapy
  • Disease process that is felt to be reversible.
  • Oxygen index ( OI ) of > 40 for more than 2 hours.

    OI = Mean airway pressure x Fio2 x 100

Pediatric ECMO

The pediatric ECMO criteria have no hard set criteria, but here are some things to consider.

  • No major bleeding problems
  • No multi-organ failure
  • Less than 7 to 14 days on high mechanical or high frequency ventilator settings.
  • 1 month to 18 years of age
  • Pneumonia
  • Flu
  • Acute respiratory failure
  • Trauma
  • Aspiration
  • Near drowning
  • Sepsis
  • Status asthmaticus
  • Other reversible lung disease

Cardiac ECMO

This is the most difficult population to give criteria for, the decision to place a pediatric cardiac patient on ECMO involves many factors. Echocardiography and Cath labs are great tools to help in this decision process, but we understand many centers may not have access to this equipment.

The following is a general list of the different type of cardiac patients that may be placed on ECMO support.

  • Post cardiac arrest
  • Cardiogenic shock
  • Cardiac failure post heart surgery
  • Pulmonary hypertension
  • Myocarditis
  • Congenital heart defects pre or post surgical with chance of survival
  • Bridge to transplant
  • Bridge to LVAD or other mechanical device.

Angel One Dispatch / 1-800-ACH-HELP

Ask to speak to the pediatric intensivist, cardiac intensivist or neonatologist on call, depending on the age of the child and primary problem.

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