ECMO

Activation of the TMCS Team:

Page 9-ECMO 24/7 to request a consult for consideration of total mechanical circulatory support. This should be done through the dashboard.

  • The 9-ECMO pager will be signed out to an attending cardiologist or intensivist who is part of the TMCS Team.
  • Note: 9-ECMO Consult should be initiated by an attending or senior EM resident. Call-back number should be a direct line or cell phone number. When in doubt, if you think a patient may need temporary mechanical circulatory support, page 9-ECMO.

Patient selection:

All patients considered for total mechanical circulatory support (TMCS) must either

1) have a reasonable chance of cardiorespiratory recovery or

2) be a likely candidate for durable LVAD and/or cardiac transplantation

Possible indications:

1) Cardiogenic shock with biventricular failure refractory to inotropes and IABP

2) Ventricular failure with or without refractory respiratory failure (MI, acute myocarditis, acute peripartum cardiomyopathy, massive PE, amniotic fluid embolus, post-cardiotomy shock)

3) Refractory respiratory failure (influenza, pneumonia, ARDS) * page intensivist first – usually MICU intensivist unless it is a surgical patient, then page SICU intensivist

Absolute contraindications:

  • Cardiac arrest with prolonged CPR
  • Chronic ESRD on HD
  • Cirrhosis
  • Life-limiting systemic illness (i.e. cancer)
  • Unable to be anti-coagulated
  • Chronic severe pulmonary HTN
  • Severe aortic insufficiency
  • Aortic dissection

Relative contraindications:

  • Multi organ system failure
  • Ongoing CPR
  • Trauma with multiple bleeding sites
  • Age greater than 65

(For difficult mechanical ventilation issues [ie, refractory hypoxemia], page on-call intensivist first.

  • Initial screening based on developed indications and relative contraindications
  • Consultant may request further testing including: transthoracic or transesophageal echocardiography, invasive hemodynamic monitoring, current ABG, or other testing at the consultant’s discretion
  • If patient does not screen out, the consultant will gather more data, see the patient in person, or initiate a discussion with other team members (interventional cardiology, CT surgery, anesthesia critical care, pulmonary critical care