Retrospective report of contraindications to extracorporeal membrane oxygenation (ECMO) among adults with acute respiratory distress syndrome (ARDS)

ObjectivesTo determine the incidence of contraindications to extracorporeal membrane oxygenation (ECMO) among adults with acute respiratory distress syndrome (ARDS) and assess the impact of contraindications on the number of patients receiving ECMO (case volume).BackgroundThe extent to which contraindications may affect case volumes has not been described.MethodsRetrospective, observational study at an academic tertiary medical center. The records of 730 consecutive patients with ARDS were queried for respiratory ECMO eligibility and ECMO contraindications.ResultsOf the 730 patients with ARDS, 168 (23.0%) met ECMO inclusion criteria and 515 (70.5%) never met ECMO eligibility due to inadequately severe disease. Among 168 patients who met ECMO inclusion criteria, 1 or more relative contraindications were present in 144 (85.7%) patients. The three most common relative contraindications were immunocompromised state (58.3%), multiorgan dysfunction (29.2%) and contraindication to anticoagulation (16.7%).ConclusionsApplication of relative contraindications may greatly affect ECMO case volumes.