- Referral to a tertiary respiratory centre should be considered in the following situations:
- Severe hypoxaemia (for example, PaO2/FiO2 <13.3kPa)
- Severe hypercapnic acidosis (for example, pH <7.20)
- Inability to achieve lung-protective tidal volumes and pressures (tidal volume < 6ml/kg predicted body weight, plateau pressure <30cmH2O)
- Failure to improve with rescue therapies such as prone positioning
- Significant air leak/bronchopleural fistula
- The most widely used indications for ECMO are those reported in the CESAR study
- The NHS specialise service clarified indications and contraindications during their commissioning service:
Indications
Contraindications
- Age ≥16 years
- Potentially reversible severe acute respiratory failure
- No limitation to on-going life-sustaining treatment
- Murray score ≥3.0 (consider referral is ≥2.5 and rapid clinical deterioration) OR
- Uncompensated hypercapnia with pH <7.20
- Age >65 years
- Intracranial bleed (current or recent)
- Other contraindications to heparinisation
- High pressure (peak inspiratory pressure >30 H2O or high FiO2 (>0.8) ventilation for more than seven days